Acute Flaccid Myelitis in an Adult
Conclusions: AFM should be included in the differential for the presentation of acute weakness in adults and pediatric patients. As the incidence of AFM continues to rise, awareness of the condition and prompt obtainment of specimens in suspected patients is crucial to aid in the investigation. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Leukoencephalopathy With Brain Stem and Spinal Cord Involvement and Lactate Elevation (LBSL): A Case With Long-term Follow-up
Conclusion: This report illustrates the clinical and magnetic resonance imaging characteristics of a slowly progressive long-term course of childhood-onset LBSL. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Two Years of Improved Neurological Function With Nusinersen in a 48-Year-Old Patient With Spinal Muscular Atrophy Type 3
Conclusions: This is the first published case of nusinersen in a middle-aged adult with spinal muscular atrophy. Sustained clinically meaningful improvement may be possible with nusinersen initiation in mid adulthood. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Acute Ischemic Stroke as a Result of Paradoxical Embolus in a Patient with Renal Cell Carcinoma, Intravenous Tumor Thrombus Extension, and Patent Foramen Ovale
Conclusions: This is the first reported case of intraoperative paradoxical embolism in the setting of RCC with cavoatrial extension and PFO. The presence of PFO may be a risk factor for severe cerebrovascular complications in the surgical management of RCC with venous involvement. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Recurrent Vertebrobasilar Strokes Associated With Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE)
Conclusions: This case illustrates the importance of careful evaluation and high clinical suspicion for this entity when dealing with patients with new-onset headache or stroke associated with visual impairment. Proper ophthalmologic evaluation is important so that adequate therapy is established. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Acute Seizures in Cerebral Venous Sinus Thrombosis: Risk Factors and Prognosis
Background: Cerebral venous sinus thrombosis (CVST) often presents with acute seizures, and recurrent seizures may also be seen in the long term in some patients. The purpose of this retrospective study was to investigate the frequency and type of acute seizures and to define the risk factors. Methods: Sixty-two patients diagnosed with CVST between September 2007 and October 2018 were retrospectively evaluated for the occurrence of acute seizures. Seizures which developed as a presenting symptom or occurred within 2 weeks of diagnosis were defined as acute seizures. Demographic, clinical, and radiologic characteristic...
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Association Between Long-term Functional Outcome and Change in hs-CRP Level in Patients With Acute Ischemic Stroke
Background and Purpose: Elevated high-sensitivity C-reactive protein (hs-CRP) has been suggested as a risk factor for ischemic stroke. However, the predictive value of hs-CRP for long-term outcomes is poorly defined. Therefore, we conducted this study to evaluate whether change in hs-CRP level plays a role in the prognostic value of long-term functional disability. Methods: We studied 263 patients with acute ischemic stroke and 104 healthy controls (67.5±11.26 and 68.17±11.21 y, respectively). hs-CRP was measured on admission and on the seventh day of hospitalization. The patients were classified ...
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Clinical Features of Trousseau Syndrome With Cerebral Infarction as the Initial Manifestation
Conclusions: Trousseau syndrome with cerebral infarction as the initial manifestation was associated with metastatic cancer and depressive state. There was no difference in coagulation status between the 2 groups. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Meta-Analysis of Perioperative Stroke and Mortality in CABG Patients With Carotid Stenosis
Conclusions: Together, these data suggest an association between stroke and mortality in the perioperative period in patients undergoing CABG, demonstrating a need for improved monitoring, screening, and treatment of stroke before, during, and shortly after surgery. (Source: The Neurologist)
Source: The Neurologist - September 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Spontaneous Intracranial Hypotension Followed by Intracranial Hypertension
Discussion: Spontaneous intracranial hypotension may predispose to subarachnoid hemorrhage through vascular compensatory changes. Blood in subarachnoid space may seal the hidden cerebrospinal fluid leak or trigger an inflammatory reaction, leading to rebound intracranial hypertension, a well-known epidural blood patch complication. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

GABA-B Receptor Encephalitis Triggered by Enterovirus Encephalitis in a Patient With Small Cell Lung Cancer: A Case Report
Conclusion: In cases of infectious encephalitis with an atypical recurrent course, the possibility of newly onset autoimmune encephalitis should be considered. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Reversible Cerebral Vasoconstriction Syndrome Following Carotid Endarterectomy: A Case Report
Conclusion: The authors advise clinicians to consider RCVS as a cause of thunderclap headache or recurrence of a severe headache shortly after CEA—particularly with the presence of a nonaneurysmal convexity SAH. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Guillain-Barré Syndrome as a Neurological Complication of Novel COVID-19 Infection: A Case Report and Review of the Literature
Conclusion: Our cases revealed the familial occurrence of Guillain-Barré syndrome after COVID-19 infection. The authors emphasize neurological complications of COVID-19. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Is Noninvasive Vagus Nerve Stimulation a Safe and Effective Alternative to Medication for Acute Migraine Control?
Conclusions: When comparing nVNS with sham, no statistically significant differences were found with regards to the primary endpoint of pain freedom at 120 minutes, although differences were found with various secondary endpoints and post hoc analysis. nVNS is likely a safe alternative to medications. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Critically Appraised Topics Source Type: research

Neurological Morbidity and Mortality in a Neurological Low-Resource Setting: A 2-Year Audit of a Nigerian Hospital
The objective of this study was to report the burden of neurological disorders, including morbidity and mortality, in adult patients at a Northwestern Nigerian tertiary hospital over a 2-year period. Materials and Methods: An audit of adult medical admissions from July 1, 2015, to June 30, 2017, was conducted. Anonymized data on medical admissions were retrieved from admission registries. Primary and secondary outcomes of interest were neurological diagnoses and clinical outcomes, respectively. The Pearson χ2 and independent t tests were used to test for differences between neurological and general medical proportio...
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Treatment of Status Epilepticus: What Are the Guidelines and Are We Following Them?
Conclusions: This retrospective review demonstrates how guidelines and recommendations for SE are not consistently followed. Under dosing of AEDs and aggressive weaning of anesthetic agents may result in higher morbidity and mortality. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

The Incidence of Central Neurological Disorders Among Patients With Isolated Dizziness and the Diagnostic Yield of Neuroimaging Studies
Conclusions: Isolated dizziness is rarely associated with central neurological pathologies. Neuroimaging studies, especially cranial CT, have low diagnostic yield in isolated dizziness and should therefore not be routine in the evaluation process. (Source: The Neurologist)
Source: The Neurologist - July 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Wall-Eyed Bilateral Internuclear Ophthalmoplegia by Ischemic Stroke: Case Report and Literature Review
Conclusion: Gaze-evoked upward nystagmus on upward gaze and bilateral limb ataxia accompanied by WEBINO due to a small brainstem lesion were the characteristic findings of our case. (Source: The Neurologist)
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Blepharospasm With Photophobia Secondary to Midbrain Tuberculoma and Thalamic Infarct
Conclusions: Our patient had tuberculoma in the midbrain and chronic infarcts in the thalamus, and both lesions may cause blepharospasm and photophobia independently, so it is difficult to ascertain the causative lesion in our patient. However, it is possible that these heterogenous lesions are all part of a single functionally connected brain network and further studies are required to confirm this hypothesis. (Source: The Neurologist)
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Morvan Syndrome and Diffuse Large B-Cell Lymphoma in the Central Nervous System
Conclusions: This is a first reported case of a patient who was concurrently diagnosed with Morvan syndrome and diffuse large B-cell lymphoma in the CNS. Additional studies are needed to determine whether aberrantly proliferating B lymphocytes are responsible for the production of Caspr2 antibodies. (Source: The Neurologist)
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

When the Temporal Artery Biopsy is Negative: A Case Series of Headache Attributed to Polymyalgia Rheumatica
Conclusions: Headache attributed to PMR is a steroid-responsive syndrome which should be considered in an older adult presenting with features of PMR, when the TAB is negative. Diagnostic criteria for headache attributed to PMR are proposed. (Source: The Neurologist)
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Effects of Baseline Systolic Blood Pressure on Outcome in Ischemic Stroke Patients With Intravenous Thrombolysis Therapy: A Systematic Review and Meta-Analysis
This study aimed to assess the relationship between baseline SBP and outcome. Materials and Methods: Studies that evaluated the association between the baseline SBP and the outcome of patients undergoing thrombolytic therapy were sought. Data were extracted according to a predefined data extraction form and then analyzed by STATA 12.0 software. The primary endpoint was the occurrence of good outcomes measured by a modified Rankin Scale score at 3 months, while the secondary endpoint was the occurrence of intracranial hemorrhage and death. Results: Eleven studies involving a total of 33,263 patients were included. Poo...
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

The Impact of Deep Brain Stimulation on the Sexual Function of Patients With Parkinson’s Disease
Conclusions: Sexual function in both sexes of patients with PD does not seem to be influenced by DBS-STN itself, but by psychological and clinical features. (Source: The Neurologist)
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Heart Rate Variability Analysis: A Useful Tool to Assess Poststroke Cardiac Dysautonomia
Background: Neurogenic heart syndrome represents a phenomenon often encountered in clinical practice after ischemic stroke. Further poststroke cardiovascular complications are possibly related to cardiac autonomic dysregulation. Multiple Trigonometric Regressive Spectral (MTRS) analysis of the heart rate variability (HRV) allows a precise evaluation of cardiovascular modulation under different conditions. Objectives: This research aims to evaluate the impact of the middle cerebral artery (MCA) ischemic stroke on cardiac autonomic function, using the MTRS analysis of HRV, during sympathetic and parasympathetic activati...
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Stroke-Associated Pneumonia: A Retrospective Study of Risk Factors and Outcomes
Introduction: Pneumonia is the most common complication after stroke, but our knowledge on risk factors and predictors of stroke-associated pneumonia (SAP) is limited. We sought to evaluate the predictors and outcomes of SAP among acute ischemic stroke (AIS) hospitalizations. Methods: This is a cross-sectional study of the Nationwide Inpatient Sample database from the year 2003 to 2014. We identified adult hospitalizations with AIS using International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The SAP was identified by the presence of a secondary diagnosis of hospital-acquired ...
Source: The Neurologist - May 1, 2020 Category: Neurology Tags: Original Articles Source Type: research

Is King-Devick Testing, Compared With Other Sideline Screening Tests, Superior for the Assessment of Sports-related Concussion?: A Critically Appraised Topic
Conclusion: K-D testing has high sensitivity and specificity for detecting sideline concussion. Compared with other sideline screening tools that do not include vision testing, it has greater accuracy. Screening for concussion is optimized when multiple testing modalities are used in conjunction. (Source: The Neurologist)
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Critically Appraised Topics Source Type: research

Nonatrial Fibrillation was Associated With Early Neurological Improvement After Intravenous Thrombolysis With rt-PA in Patients With Acute Ischemic Stroke
Background: Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient. Objective: To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset. Methods: Demographics, onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at a Chinese hospital between January 2013 and Au...
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Original Article Source Type: research

Thrombolysis for Acute Ischemic Stroke Following Transcatheter Aortic Valve Replacement: Case Report and Literature Review
Conclusion: Previously undescribed, we suggest that tPA should be considered for post-TAVR AIS patients who otherwise satisfy inclusion and exclusion criteria. (Source: The Neurologist)
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Treating Paroxysmal Sympathetic Hyperactivity With Enteral Baclofen in Anoxic Brain Injury
Conclusion: This case series reviews the current therapies used for PSH and discusses 2 patients with uncontrolled PSH secondary to anoxic brain injury. Both patients arose from coma and had significant symptomatic improvement with enteral baclofen treatment. Thus, enteral baclofen should be considered as a primary treatment for PSH to prevent sustained symptoms and prolonged hospitalizations. (Source: The Neurologist)
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Case Report/Case Series Source Type: research

Feasibility of a Nonmydriatic Ocular Fundus Camera in an Outpatient Neurology Clinic
Conclusions: Using nonmydriatic fundus photography in an outpatient neurology clinic is feasible without disrupting patient flow or causing patient discomfort. Findings of optic nerve pallor, optic nerve swelling, or normal optic nerves were particularly relevant to these patients seen for headaches or demyelinating disease and helped inform immediate diagnosis and management. (Source: The Neurologist)
Source: The Neurologist - March 1, 2020 Category: Neurology Tags: Original Article Source Type: research

Relationship Between Sleep Characteristics and Sudden Unexplained Death Risk in Epilepsy: Erratum
No abstract available (Source: The Neurologist)
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Erratum Source Type: research

MRI Punctate Sign and CTA Spot Sign for Primary Intracerebral Hemorrhage
No abstract available (Source: The Neurologist)
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Letter to the Editor Source Type: research

A Probable Case of Recurrent Bickerstaff Brainstem Encephalitis With Fulminant Course in a Pediatric Patient
Conclusion: Although Bickerstaff brainstem encephalitis tends to involve the brainstem, outcomes of brain death have been rarely reported, even more so in the pediatric age group. This case report sheds light on, possibly, the first reported fatality of Bickerstaff encephalitis among children. (Source: The Neurologist)
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Clinical Usefulness of Cell-Free DNA as a Prognostic Marker in Acute Ischemic Stroke
Objective: Stroke has become the second most common cause of death. Several biomarkers have been detected in the peripheral blood from stroke patients, but none has found a place in clinical practice. Cell-free DNA (cf-DNA) liberated into the blood soon after the onset of stroke might be useful for assessing disease severity and prognosis. Study Design and Methods: A total of 54 patients presenting with ischemic stroke were recruited consecutively with the exclusion of patients having trauma, tumor, infections, and organ failure. The cf-DNA was extracted by circulating nucleic acid kit from Qiagen and measured by real...
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Original Article Source Type: research

Low Heteroplasmy Rates Argue Against the m.3243A>G Variant as the Cause of Auditory Agnosia
No abstract available (Source: The Neurologist)
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Letter to the Editor Source Type: research

Protean Manifestations and Diagnostic Challenges Including Discordance Between Electrodiagnostic-Radiologic Studies in Neurolymphomatosis
Conclusion: This clinical phenotype reinforces previously reported presentations of neurolymphomatosis and the ability of multimodal diagnostics, when combined with clinical suspicion phenotype, to enable diagnosis of malignant lymphocytic infiltration of the CNS and PNS. (Source: The Neurologist)
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Myasthenia Gravis Crisis and Atrial Fibrillation
Conclusion: New-onset AF can occur during MG crisis. The cardiac outcome improves with treatment of the underlying disease, after initial cardiac stabilization. (Source: The Neurologist)
Source: The Neurologist - December 31, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Leukoencephalopathy With Predominant Infratentorial Involvement Caused by a Novel ABCD1 Mutation: Does the Spinocerebellar Variant of Adrenoleukodystrophy Exist?
Conclusions: X-ALD should be included in the differential diagnosis of adult leukoencephalopathies with predominant involvement of infratentorial structures, that is, the cerebellum and brainstem. From a classification perspective, our patient (of white origin), like others (all of Asian origin), should be considered as suffering from a variant of adrenomyeloneuropathy rather than from spinocerebellar X-ALD. Actually, the term “spinocerebellar” or similar ones, such as “cerebello-brainstem dominant form,” should be limited to those exceptional cases, in which both the clinical and neuroimaging fin...
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Papilledema and Peripheral Neuropathies
Conclusions: Based on a personal case report and from an extensive review of the medical literature, we identify 2 distinct patterns. First, radiculoneuropathy may be a consequence of intracranial pressure (peripheral nerve involvement corresponding to a “false localizing sign”). Second, papilledema may occur after the onset of inflammatory neuropathy. For such cases, the pathophysiological mechanism remains unknown (eg, reactional inflammatory processes or actions of unknown autoantibodies) and requires further elucidation. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Successful Thrombolysis in the Setting of Marfan Syndrome and Chronic Aortic Dissection
Conclusion: To our knowledge, this is the first case of Marfan syndrome with chronic aortic dissection undergoing thrombolysis for acute ischemic stroke with a near-complete recovery of neurological deficit and favorable long-term outcome. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion
Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Intraosseous Administration of Hypertonic Saline in Acute Brain-Injured Patients: A Prospective Case Series and Literature Review
Conclusions: In this prospective case series, IO administration of 3% HTS was feasible, well-tolerated on the basis of nonverbal indicators of pain in the majority of patients and resulted in an appropriate rise in serum sodium levels. IO fills a niche among vascular access options for HTS, in emergent neurological situations when central venous access is not readily available or peripheral intravenous access is difficult to obtain. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Relationship Between Sleep Characteristics and Sudden Unexplained Death Risk in Epilepsy
Conclusion: Our results emphasized a remarkable magnitude of the comorbidity of sleep disorders in patients with epilepsy, even for those who do not have complaints about sleep. As SUDEP cases are frequently seen during sleep, it is important to evaluate sleep in patients with epilepsy. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Original Articles Source Type: research

Bronzino’s Claw Hand
Conclusion: There is in fact no portrayal of a unilateral ulnar pathology. If it were, then it means that many of Bronzino’s subjects suffered from exactly the same condition. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Original Articles Source Type: research

A Cross-Sectional Analysis of Migraine-Related Disability in CADASIL: A Mayo Clinic Cohort
Conclusions: A bimodal distribution of migraine-related disability was observed. A third of individuals had a severe disability and appeared medically refractory to medical migraine prophylactic measures. This study may serve as a reference point for future trials quantitatively gauging response of novel migraine treatment strategies within this unique population. (Source: The Neurologist)
Source: The Neurologist - November 1, 2019 Category: Neurology Tags: Original Articles Source Type: research

Cause or Consequence: The Relationship Between Cerebral Venous Thrombosis and Idiopathic Intracranial Hypertension
Conclusion: CSVT is a common clinical entity among the causes of IIHT, and it should be taken into consideration in this patient group. However, there is a need for a common guideline for laboratory and imaging methods to understand the etiopathogenesis of childhood IIHT and determine the patients at risk. (Source: The Neurologist)
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Original Article Source Type: research

Glial Fibrillary Acidic Protein (GFAP) Autoimmunity in the Setting of Seropositive Rheumatoid Arthritis Treated With Etanercept
Conclusion: This case expands on the previously reported cases of GFAP immunoglobulin G autoimmunity by describing an associated inflammatory large fiber peripheral neuropathy. (Source: The Neurologist)
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Dupuytren, Ledderhose, and Peyronie Diseases After Primidone Use For Essential Tremor
Conclusions: There are a few reports associating barbiturate use to connective tissue disorders, and some suggest that drug withdrawal may result in a better prognosis. Therefore, physicians must be aware of such adverse events when caring for patients on long-term barbiturate use. (Source: The Neurologist)
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Intravenous Thrombolysis For Acute Ischemic Stroke in Fabry Disease
Conclusion: The present case supports the scarce data underscoring the safety of intravenous thrombolysis for acute ischemic stroke in Fabry disease patients even when cerebral microbleeds are present. (Source: The Neurologist)
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research

Safety of Early Repeated Thrombolysis: A Case Report
Conclusion: This case report suggests that further randomized studies may evaluate whether repeated IVtPA may be safe and effective in ERS occurring shortly after a previous stroke when patients experience a period of complete neurological regression, minor disability, and a small infarct volume. Should the hypothesis be confirmed, small volume core and wide volume penumbra at perfusion CT may support the decision of adopting IVtPA repetition. (Source: The Neurologist)
Source: The Neurologist - September 1, 2019 Category: Neurology Tags: Case Report/Case Series Source Type: research