Successful Management of Two Patients with Intracranial Hemorrhage due to Carpet Viper (Echis ocellatus) Envenomation in a Limited-Resource Environment
We present 2 cases of E ocellatus envenomation with intracranial hemorrhage seen at a rural hospital in Bembèrèkè, Benin, and describe the successful management of these patients in a limited-resource setting. In one case the patient was treated with an ineffective Indian-made antivenom before evaluation by the authors and continued to deteriorate until she was treated with effective antivenom 10 d after the bite. In both cases lumbar puncture was performed for diagnostic or therapeutic purposes with good effect, and both patients made full recoveries without sequelae. These cases demonstrate the remar...
Source: Wilderness and Environmental Medicine - June 21, 2019 Category: Environmental Health Source Type: research

A pilot study of the utility of cerebrospinal fluid neurofilament light chain in differentiating neurodegenerative from psychiatric disorders: A 'C-reactive protein' for psychiatrists and neurologists?
CONCLUSION: Cerebrospinal fluid neurofilament light shows promise as a diagnostic test to assist with the often challenging diagnostic dilemma of distinguishing psychiatric disorders from neurodegenerative and neurological disorders. Further studies are warranted to replicate and expand on these findings, including on plasma neurofilament light. PMID: 31220922 [PubMed - as supplied by publisher] (Source: The Australian and New Zealand Journal of Psychiatry)
Source: The Australian and New Zealand Journal of Psychiatry - June 21, 2019 Category: Psychiatry Authors: Eratne D, Loi SM, Walia N, Farrand S, Li QX, Varghese S, Walterfang M, Evans A, Mocellin R, Dhiman K, Gupta V, Malpas CB, Collins S, Masters CL, Velakoulis D Tags: Aust N Z J Psychiatry Source Type: research

Does CSF pleocytosis have a predictive value for disease course in MS?
Objective MS is a demyelinating CNS disorder with a spectrum of clinical patterns regarding course and prognosis. Although several prognostic factors are considered in the initial evaluation of patients, biological markers defining the disease course and guiding treatments are currently lacking. It is unknown whether patients with CSF pleocytosis differ in regard to symptoms, disease course, and prognosis from those without. The aim of this study was to evaluate whether CSF pleocytosis during the initial presentation has an impact on the clinical course and progression of MS. Methods We retrospectively evaluated patients ...
Source: Neurology Neuroimmunology and Neuroinflammation - June 18, 2019 Category: Neurology Authors: Lotan, I., Benninger, F., Mendel, R., Hellmann, M. A., Steiner, I. Tags: All Immunology, Prognosis, All Demyelinating disease (CNS), Multiple sclerosis Article Source Type: research

Correlates of HIV RNA concentrations in cerebrospinal fluid during antiretroviral therapy: a longitudinal cohort study
Publication date: Available online 14 June 2019Source: The Lancet HIVAuthor(s): Alessandro Livelli, Florin Vaida, Ronald J Ellis, Qing Ma, Micol Ferrara, David B Clifford, Ann C Collier, Benjamin B Gelman, Christina M Marra, Justin C McArthur, J Allen McCutchan, Susan Morgello, Ned Sacktor, David M Simpson, Igor Grant, Scott L Letendre, Ian Abramson, Muhammad T. Al-Lozi, Sarah L. Archibald, J. Hampton AtkinsonSummaryBackgroundFew large projects have evaluated the factors that influence the HIV RNA concentrations (viral load) in cerebrospinal fluid (CSF) during antiretroviral therapy (ART) over time. We aimed to determine t...
Source: The Lancet HIV - June 16, 2019 Category: Infectious Diseases Source Type: research

Biomarkers for Alzheimer's Disease in Saliva: A Systematic Review.
Conclusion: Aβ42 and tau seem to be worthy candidates for future salivary biomarkers for AD, but other biomarkers such as lactoferrin and selected metabolites also have potential. More studies must be carried out with larger sample sizes and a standardization of the sampling and processing method. Factors such as diurnal variation, AD patients' decreased ability of oral self-care, and salivary flowrates must be taken into consideration. PMID: 31191751 [PubMed - in process] (Source: Disease Markers)
Source: Disease Markers - June 15, 2019 Category: Laboratory Medicine Tags: Dis Markers Source Type: research

Developing a Spatial Navigation Screening Tool Sensitive to the Preclinical Alzheimer Disease Continuum.
CONCLUSIONS: These findings suggest that a self-report questionnaire and aspects of a cognitive mapping task may be particularly appropriate for development as screening tools for identifying individuals in the preclinical AD continuum. PMID: 31197326 [PubMed - as supplied by publisher] (Source: Archives of Clinical Neuropsychology)
Source: Archives of Clinical Neuropsychology - June 14, 2019 Category: Psychiatry & Psychology Authors: Allison SL, Rodebaugh TL, Johnston C, Fagan AM, Morris JC, Head D Tags: Arch Clin Neuropsychol Source Type: research

Association of Intracranial Hypertension With Calvarial and Skull Base Thinning
Objective: Determine if patients with increased opening pressure (OP) on lumbar puncture (LP) have thinner calvaria and skull bases. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Patients (≥18 yr of age) who had a recorded OP on LP and high-resolution computed tomography imaging of the head. Patient age, sex, body mass index were calculated. Intracranial hypertension (IH) was defined with an OP≥25 cm-H2O and low intracranial pressure with an OP (Source: Otology and Neurotology)
Source: Otology and Neurotology - June 13, 2019 Category: ENT & OMF Tags: MIDDLE EAR AND MASTOID DISEASE Source Type: research

Hypothyroidism manifesting as multiple cranial neuropathies: a case report
We present an uncommon clinical presentation of a 38-year-old Caucasian man with mild facial palsy on the left side, uvular deviation to the left with preserved gag reflex, tongue deviation to the left, lingual dysarthria, and xerosis by severe hypothyroidism. Blood tests on admission showed elevated serum creatinine of 151  μmol/L (glomerular filtration rate 47 ml/min/1.7 CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration equation]), increased creatinine phosphokinase activity (1243 U/L), markedly elevated thyroid-stimulating hormone (292.2 mIU/L), low free thyroxine level (1.1 pmol/...
Source: Journal of Medical Case Reports - June 13, 2019 Category: General Medicine Source Type: research

Cancers, Vol. 11, Pages 824: Improving the Brain Delivery of Chemotherapeutic Drugs in Childhood Brain Tumors
pozza Ruggiero The central nervous system (CNS) may be considered as a sanctuary site, protected from systemic chemotherapy by the meninges, the cerebrospinal fluid (CSF) and the blood-brain barrier (BBB). Consequently, parenchymal and CSF exposure of most antineoplastic agents following intravenous (IV) administration is lower than systemic exposure. In this review, we describe the different strategies developed to improve delivery of antineoplastic agents into the brain in primary and metastatic CNS tumors. We observed that several methods, such as BBB disruption (BBBD), intra-arterial (IA) and intracavitary chemo...
Source: Cancers - June 13, 2019 Category: Cancer & Oncology Authors: Triarico Maurizi Mastrangelo Attin à Capozza Ruggiero Tags: Review Source Type: research

Swollen optic nerve: an approach to diagnosis and management.
Abstract The differential diagnosis of swollen optic nerves differs according to whether the swelling is unilateral or bilateral, or whether visual function is normal or affected. Patients with a unilaterally swollen optic nerve and normal visual function most likely have optic nerve head drusen. Patients with abnormal visual function most likely have demyelinating optic neuritis or non-arteritic anterior ischaemic optic neuropathy. Patients with bilaterally swollen optic nerve heads and normal visual function most likely have papilloedema, and require neuroimaging followed by lumbar puncture. However, if their vi...
Source: Practical Neurology - June 13, 2019 Category: Neurology Authors: Margolin E Tags: Pract Neurol Source Type: research

Leptin, Anxiety Symptoms, and Hypothalamic-Pituitary-Adrenal Axis Activity among Drug-Free, Female Suicide Attempters
Conclusions: These findings suggest that in females with a recent suicide attempt, low CSF leptin may be related to symptoms of anxiety and a hyperactive HPA axis.Neuropsychobiology (Source: Neuropsychobiology)
Source: Neuropsychobiology - June 12, 2019 Category: Psychiatry & Psychology Source Type: research

The Influence of Blood Contamination on Cerebrospinal Fluid Diagnostics
Conclusion: Erythrophages and siderophages do not develop in vitro. An extensive diagnostic work up for the source of blood in the CSF should be performed when erythrophages or siderophages are found in the CSF. The contamination of CSF with increasing volume of blood resulted in falsely elevated CSF protein concentrations. Hence, the amount of blood contamination has to be taken into consideration when interpreting CSF protein measurement results. (Source: Frontiers in Neurology)
Source: Frontiers in Neurology - June 12, 2019 Category: Neurology Source Type: research

Current Hospital Demographics of Subarachnoid Hemorrhage Based on CT Angiography and 3D Rotational Angiography in a Neurosurgical Center [ADULT BRAIN]
CONCLUSIONS: This study provides robust data on hospital demographics of SAH in a neurosurgical referral center, based on CTA and 3D rotational angiography of all vessels. (Source: American Journal of Neuroradiology)
Source: American Journal of Neuroradiology - June 12, 2019 Category: Radiology Authors: van Rooij, S. B. T., Bechan, R. S., van Rooij, W. J., Sprengers, M. E. Tags: ADULT BRAIN Source Type: research

Selection of Patients’ Recumbent Position Laterality According to Physician Handedness Bias Increases the Success Rate of Lumbar Puncture: A Multicenter Study
Conclusions: Physicians handedness bias and patient laterality of recumbent position affects the success of LPs. Right-handed physicians have a greater chance of performing successful LPs when patients are in the left LRP, and vice versa. (Source: Journal of Neurosurgical Anesthesiology)
Source: Journal of Neurosurgical Anesthesiology - June 11, 2019 Category: Anesthesiology Tags: Clinical Investigations Source Type: research

Assessment of ctDNA in CSF may be a more rapid means of assessing surgical outcomes than plasma ctDNA in glioblastoma
Publication date: Available online 4 June 2019Source: Molecular and Cellular ProbesAuthor(s): Jue-hui Li, Zhen-qiang He, Fu-hua Lin, Zheng-he Chen, Shi-yu Yang, Hao Duan, Xiao-bing Jiang, Fuad Al-Nahari, Xiang-heng Zhang, Jiang-huang Wang, Guan-hua Zhang, Zhen-feng Zhang, Cong Li, Yong-Gao MouAbstractWe aimed to develop a high-throughput deep DNA sequencing assay of cerebrospinal fluid (CSF) to identify clinically relevant oncogenic mutations that contribute to the development of glioblastoma (GBM) and serve as biomarkers to predict patients' responses to surgery. For this purpose, we recruited five patients diagnosed with...
Source: Molecular and Cellular Probes - June 5, 2019 Category: Molecular Biology Source Type: research

Etiology of Central Nervous System Infections in a Rural Area of Nepal Using Molecular Approaches.
In conclusion, the etiology could not be found in 77% of the samples, indicating that the commercial PCR panels used are not suitable in this setting. Future studies on the etiology of CNS infections in Nepal could include metagenomic techniques. PMID: 31162021 [PubMed - as supplied by publisher] (Source: The American Journal of Tropical Medicine and Hygiene)
Source: The American Journal of Tropical Medicine and Hygiene - June 3, 2019 Category: Tropical Medicine Authors: Säll O, Thulin Hedberg S, Neander M, Tiwari S, Dornon L, Bom R, Lagerqvist N, Sundqvist M, Mölling P Tags: Am J Trop Med Hyg Source Type: research

Blood and cerebrospinal fluid characteristics in neonates with a suspected central nervous system infection
This study provides an overview of microbiological test results, CSF- and hematological characteristics among infants with a clinically suspected CNS infection. This retrospective study included infants younger than 90 days, with a clinically suspected CNS infection who underwent a diagnostic lumbar puncture between January 2012 and January 2014. Data on the presence of microbiological pathogens in CSF, CSF inflammation markers (white blood cell [WBC] counts, protein levels and glucose CSF/serum ratio) and blood inflammatory responses (WBC count, C-reactive protein [CRP], neutrophil percentage) were collected by reviewing...
Source: Medicine - June 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Cinical and ENMG findings in patients with rare variants of Guillain Barré Syndrome
ConclusionThe PCB and MFS variant are rare forms of GBS. Ataxia commonly described in both of our cases may lead to overlapping syndrome and supports the view that PCB and MFS belongs to a continuous spectrum. Ataxia makes also difficult to differentiate these clinical entities from brainstem injury. However, areflexia and ENMG help to make the diagnosis. Further studies are needed to clarify whether these entities have specific patterns in electrophysiological studies. (Source: Neurophysiologie Clinique)
Source: Neurophysiologie Clinique - May 30, 2019 Category: Neuroscience Source Type: research

[Incidence of alarm criteria and attitude towards patients with headache attended in emergency departments].
CONCLUSIONS: Only one out of every two patients meets the alarm criteria. The proportion of severe secondary headache is really low. The multidisciplinary management of headache needs to be improved in our setting to prevent people visiting the emergency department due to primary headaches without any alarm criteria. PMID: 31132134 [PubMed - in process] (Source: Revista de Neurologia)
Source: Revista de Neurologia - May 29, 2019 Category: Neurology Authors: Vidal-Castello M, Olivart-Parejo M, Abadias-Medrano MJ, Purroy F Tags: Rev Neurol Source Type: research

Life-threatening Listeria meningitis: Need for revision of South African acute bacterial meningitis treatment guidelines.
CONCLUSIONS: Our two cases demonstrate that the listeriosis outbreak should change the way we view bacterial meningitis in SA: according to the National Institute for Communicable Diseases, empirical treatment for meningitis should include ampicillin and gentamicin in all adult patients with features of meningitis. There may be a need for an updated meningitis treatment guideline in SA. PMID: 31131793 [PubMed - in process] (Source: South African Medical Journal)
Source: South African Medical Journal - May 29, 2019 Category: African Health Tags: S Afr Med J Source Type: research

Patients on NOACs in the Emergency Room
AbstractPurpose of ReviewDespite the increasing use of NOACs, there is still uncertainty on how to treat NOAC patients presenting with neurological emergencies. Initial assessment of coagulation status is challenging but essential in these patients to provide best-possible treatment in case of ischemic or hemorrhagic stroke. Meanwhile, anticoagulation reversal strategies have been suggested; yet, the optimal management is still unestablished. The current review aims to provide up-to-date information on (i) how to identify patients with NOAC intake, (ii) which therapies are feasible in the setting of ischemic and hemorrhagi...
Source: Current Neurology and Neuroscience Reports - May 29, 2019 Category: Neuroscience Source Type: research

Cerebrospinal fluid biomarkers in patients with central nervous system infections: a retrospective study.
CONCLUSION: This work demonstrates that CSF biomarkers of neuronal damage or inflammation may vary during CNS infections according to different causative agents. The prognostic value of these biomarkers needs to be assessed in prospective studies. PMID: 31130152 [PubMed - as supplied by publisher] (Source: CNS Spectrums)
Source: CNS Spectrums - May 27, 2019 Category: Neurology Authors: Di Stefano A, Alcantarini C, Atzori C, Lipani F, Imperiale D, Burdino E, Audagnotto S, Mighetto L, Milia MG, Di Perri G, Calcagno A Tags: CNS Spectr Source Type: research

Crowned dens syndrome: a neurologist ’s perspective
We present a 48-year-old woman presenting with an inflammatory meningitis-like syndrome with headache and neck stiffness. Lumbar puncture was normal and computed tomography (CT) of the atlantoaxial joint showed abnormal calcifications around the odontoid process, leading to a tentative diagnosis of crowned dens syndrome. In addition, signs of active inflammation in and around the dens were present on cervical MR imaging. Since CDS can mimic meningitis or giant-cell arteritis, neurologists should be aware of this entity. If CDS is suspected, the bone window on the head CT scan can lead to the diagnosis. On the other hand, a...
Source: Acta Neurologica Belgica - May 24, 2019 Category: Neurology Source Type: research

Estimating the Lumbar Puncture Needle Depth in Children.
Conclusion: The formula may provide a more reliable estimate of the required LP depth in children than that obtained using current models. However, larger studies are needed to standardize the formula. PMID: 31116047 [PubMed - as supplied by publisher] (Source: Journal of Investigative Surgery)
Source: Journal of Investigative Surgery - May 23, 2019 Category: Surgery Tags: J Invest Surg Source Type: research

Immune reconstitution inflammatory syndrome causing progressive optic nerve edema in cryptococcal meningitis
Conclusion: Recurrent optic disk edema with loss of vision after treatment of cryptococcal meningitis in the setting of normal intracranial pressure may represent a unique manifestation of immune reconstitution inflammatory syndrome localized to the optic nerve without uveitis. This is consistent with the temporal relationship between starting highly active antiretroviral therapy, CD4+ count recovery, and the development of progressive disk edema in the study patient. Isolated optic nerve inflammation as a manifestation of immune reconstitution inflammatory syndrome has not been widely reported. (Source: Retinal Cases and Brief Reports)
Source: Retinal Cases and Brief Reports - May 23, 2019 Category: Opthalmology Tags: Case Report Source Type: research

The effect of CSF drain on the optic nerve in idiopathic intracranial hypertension
ConclusionThe findings support the hypothesis that the elevation of intracranial pressure induces a microstructural compression of the optic nerve impairing axoplasmic flow and thereby causing the prelaminar papilledema. The microstructural compression of the optic nerve as well as the clinical symptoms improve within hours of normalization of intracranial pressure. (Source: The Journal of Headache and Pain)
Source: The Journal of Headache and Pain - May 23, 2019 Category: Neurology Source Type: research

Identifying Incidence of and Risk Factors for Fluoroscopy-Guided Lumbar Puncture and Subsequent Persistent Low-Pressure Syndrome in Patients With Idiopathic Intracranial Hypertension
Conclusions: The incidence of low-pressure syndrome, as measured by blood patches, is similar in IIH patients and MS controls. This suggests that having elevated intracranial pressure before an LP is not protective against developing postpuncture low-pressure syndrome, contrary to common assumptions. (Source: Journal of Neuro-Ophthalmology)
Source: Journal of Neuro-Ophthalmology - May 21, 2019 Category: Opthalmology Tags: Clinical Research: Epidemiology Meets Neuro-Ophthalmology Source Type: research

Is Positioning During Lumbar Puncture Clinically Significant?
No abstract available (Source: Journal of Neuro-Ophthalmology)
Source: Journal of Neuro-Ophthalmology - May 21, 2019 Category: Opthalmology Tags: Point Counter-Point Source Type: research

Age matters: Impact of data-driven CSF protein upper reference limits in Guillain-Barre syndrome
Conclusions The low sensitivity of CSF-TP for the diagnosis of GBS is exacerbated by age-adjusted upper limits. The main role of lumbar puncture in GBS in the first week may be to help exclude other inflammatory or neoplastic etiologies of acute neuropathy. After the first week, the magnitude of the CSF-TP rise reduces the effect of different upper reference limits. (Source: Neurology Neuroimmunology and Neuroinflammation)
Source: Neurology Neuroimmunology and Neuroinflammation - May 21, 2019 Category: Neurology Authors: Bourque, P. R., Brooks, J., McCudden, C. R., Warman-Chardon, J., Breiner, A. Tags: All Clinical Neurology, Peripheral neuropathy, Guillain-Barre syndrome, Cerebrospinal Fluid Article Source Type: research

Iatrogenic Nontraumatic CPAP-Induced Pneumocephalus in a Patient With Meningitis
We describe a case of a patient who presented with meningitis due to an atypical organism that usually resides in the oral cavity, and who developed nontraumatic pneumocephalus in the hospital due to CPAP therapy. The underlying cause, a cerebrospinal fluid leak, was likely the mediator for both pathologies. In the setting of the increasing prevalence of obstructive sleep apnea, physicians can benefit from being aware of this atypical presentation of meningitis and atypical complication of CPAP therapy.Citation:Charokopos A, Card ME, Manes RP, Shaw A. Iatrogenic nontraumatic CPAP-induced pneumocephalus in a patient with me...
Source: Journal of Clinical Sleep Medicine : JCSM - May 15, 2019 Category: Sleep Medicine Source Type: research

Reduced Jet Velocity in Venous Flow after CSF Drainage: Assessing Hemodynamic Causes of Pulsatile Tinnitus [HEAD & NECK]
CONCLUSIONS: Our results show a lumbar puncture–induced reduction in venous peak velocity without a concomitant reduction in flow rate. We hypothesize that the reduction is caused by the expansion of the stenosis after lumbar puncture. Our results further show a correlation between the peak velocity and pulsatile tinnitus intensity, suggesting the flow jet to be instrumental in the development of sound. (Source: American Journal of Neuroradiology)
Source: American Journal of Neuroradiology - May 15, 2019 Category: Radiology Authors: Haraldsson, H., Leach, J. R., Kao, E. I., Wright, A. G., Ammanuel, S. G., Khangura, R. S., Ballweber, M. K., Chin, C. T., Shah, V. N., Meisel, K., Saloner, D. A., Amans, M. R. Tags: HEAD & amp; NECK Source Type: research

Low-Dose Oral Ketamine for Procedural Analgesia in Pediatric Cancer Patients Undergoing Lumbar Puncture at a Resource-Limited Cancer Hospital in India
Journal of Palliative Medicine, Ahead of Print. (Source: Journal of Palliative Medicine)
Source: Journal of Palliative Medicine - May 15, 2019 Category: Palliative Care Authors: Spandana Rayala Tim B äckdahl Naresh Reddy Jean Jacob Erik Gebre-Medhin Emil Karonen Gayatri Palat Sudha Sinha Tommy Schyman Thomas Wiebe Eva Brun Mikael Segerlantz Source Type: research

Biochemical Differences Between Vitreous Humor and Cerebral Spinal Fluid in a Death From Diabetic Ketoacidosis
We present a case report of a 21-year-old man who died of diabetic ketoacidosis confirmed at autopsy. Ventricular system, LP, and VH were biochemically analyzed and showed that glucose was highest in VH (41 mmol/L) and was 6 and 8 mmol/L higher than CSF in the LP and VA, respectively. β-Hydroxybutyrate was also highest in VH (20 mmol/L) and was 5 and 6 mmol/L higher than LP and VA, respectively. Our findings suggest that postmortem CSF glucose and β-hydroxybutyrate may not truly reflect that of VH and vary between CSF sampling sites. (Source: The American Journal of Forensic Medicine and Pathology)
Source: The American Journal of Forensic Medicine and Pathology - May 14, 2019 Category: Forensic Medicine Tags: Case Reports Source Type: research

An Educational Video Improves Consent in Pediatric Lumbar Puncture: A Randomized Control Trial
Lumbar puncture is a low-risk procedure performed on pediatric patients for a variety of indications. Parents are consented to this procedure but are often left with concerns. There are no published studies on the nature of the concerns of parents in North America, and no studies examining a process to improve pediatric lumbar puncture consent. (Source: Pediatric Neurology)
Source: Pediatric Neurology - May 13, 2019 Category: Neurology Authors: Mary Dunbar, Gillian Paton, Ashutosh Singhal Tags: Research Paper Source Type: research

Unusual localization of bleeding under acenocoumarol: Spinal subdural hematoma
ConclusionSSH is a rare situation of acenocoumarol bleeding incident, it should be evoked in any patient treated by this molecule with signs of spinal cord compression. (Source: International Journal of Surgery Case Reports)
Source: International Journal of Surgery Case Reports - May 10, 2019 Category: Surgery Source Type: research

Can simulation-based education and precision teaching improve paediatric trainees ’ behavioural fluency in performing lumbar puncture? A pilot study
This study assessed the efficacy of simulation-based education with frequency building and precision teaching f... (Source: BMC Medical Education)
Source: BMC Medical Education - May 10, 2019 Category: Universities & Medical Training Authors: Sin éad Lydon, Bronwyn Reid McDermott, Ethel Ryan, Paul O’Connor, Sharon Dempsey, Chloe Walsh and Dara Byrne Tags: Research article Source Type: research

Normal Pressure Hydrocephalus with Primary Presentation of Psychiatric Disturbance: Case Report
Conclusion We believe this case report is a unique description of NPH symptomology and might guide future research or clinical decision making. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Journal of Neurological Surgery Part A: Central European Neurosurgery)
Source: Journal of Neurological Surgery Part A: Central European Neurosurgery - May 10, 2019 Category: Neurosurgery Authors: Kogan, Michael Agyei, Justice Cuddahee, Kevin J. Gibbons, Kevin J. Tags: Case Report Source Type: research

Medical students' attitudes toward lumbar puncture —And how to change
ConclusionA single standardized LP seminar with simulation training alters medical students' attitudes toward LP through improving their level of knowledge and confidence. This may have important implications in doctors ‐to‐be on their stance toward LP and resultant advice to future patients regarding this important procedure. (Source: Brain and Behavior)
Source: Brain and Behavior - May 6, 2019 Category: Neurology Authors: Moritz Cranach, Tilo Backhaus, Jochen Brich Tags: ORIGINAL RESEARCH Source Type: research

CSF Protein Concentration Shows No Correlation With Brain Volume Measures
Conclusion: Accounting for brain volume derived from brain MRI is unlikely to improve the diagnostic value of protein concentrations in CSF. Introduction Cerebrospinal fluid (CSF) analysis is supportive of the diagnosis of many neurological diseases. CSF protein concentrations constitute a mainstay of CSF analysis. Despite age- and sex-dependent cut-offs (1–4), considerable interindividual variance may lower the diagnostic value of CSF protein concentrations. We aimed to reduce variance of CSF protein concentrations and, hence, to increase their diagnostic value by considering brain volumes derived from magne...
Source: Frontiers in Neurology - May 3, 2019 Category: Neurology Source Type: research

Pediatric spinal cord biopsy: A case series from a high-volume referral center
We report our experience with five patients who met our inclusion criteria. Due to the rarity of the procedure, statistically significant factors associated with improved diagnostic yield or peri-operative complication could not be identified. A definitive diagnosis which guided the post-operative treatment plan was obtained in four of our five patients. None of our patients developed post-operative motor deficits. However, these patients were susceptible to the same risks of open spine surgery, such as wound infections and spinal deformities. Our case series shows that intramedullary spinal cord biopsies may provide tissu...
Source: Journal of Clinical Neuroscience - May 1, 2019 Category: Neuroscience Source Type: research

Spontaneous intracranial hypotension in Hashimoto's thyroiditis: A case report
Rationale: Autoimmune thyroid diseases (ATDs) seldom affect intracranial pressure. Here, we describe a case of spontaneous intracranial hypotension (SIH) related to Hashimoto's thyroiditis (HT), which has never been previously published. Patient concerns: A 54-year-old woman was admitted to our hospital due to sudden-onset postural headache, neck pain stiffness, visual blurring, nausea and vomiting. The headache was aggravated when the patient sat or stood up yet rapidly resolved within 1 minute after recumbency. Diagnosis: The patient had a grade 1a diffusely palpable thyroid gland and the laboratory report reveal...
Source: Medicine - May 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Hyponatremia in Children With Bacterial Meningitis
Feixia Zheng1*, Xiuyun Ye1, Xulai Shi1, Zhongdong Lin1, Zuqin Yang1 and Longxiang Jiang2* 1Department of Pediatrics, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China 2Department of Respiratory Medicine, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China Background: Hyponatremia has frequently been described as a common complication associated with bacterial meningitis, though its frequency and clinical course in children with bacterial meningitis are unclear. The present study aimed to investigate the freque...
Source: Frontiers in Neurology - April 30, 2019 Category: Neurology Source Type: research

Guillain –Barré Syndrome Associated With Zika Virus Infection: A Prospective Case Series From Mexico
Conclusion: Our results are similar to those reported from the state of Veracruz, Mexico, in which out of 33 samples of urine of patients with GBS two had a positive RT-PCR for ZIKV. Simultaneous processing of serum, CSF, urine, and saliva by RT-PCR may increase the success of diagnosis of GBS associated to ZIKV. Introduction In April 2016, a report of Epidemiological Surveillance for Zika virus (ZIKV) disease in Mexico reported 93 autochthonous laboratory-confirmed cases, collected between November 2015 and February 2016, and distributed amongst eight states of the country (1). In these patients, clinical manifest...
Source: Frontiers in Neurology - April 30, 2019 Category: Neurology Source Type: research

Update and advances in community acquired bacterial meningitis
Purpose of review Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens. Recent findings Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic...
Source: Current Opinion in Infectious Diseases - April 26, 2019 Category: Infectious Diseases Tags: CNS INFECTIONS: Edited by Adarsh Bhimraj Source Type: research

Seizure and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Encephalomyelitis in a Retrospective Cohort of Chinese Patients
Conclusions: Seizures and encephalopathy are not rare in MOG encephalomyelitis, and are commonly associated with cortical and subcortical brain lesions. MOG-encephalomyelitis often presents with clinical meningoencephalitis symptoms and abnormal CSF findings mimicking central nervous system infection in pediatric and young adult patients. Background Immunoglobulin-G against myelin oligodendrocyte glycoprotein (MOG-IgG) is considered a potential demyelinating disease-associated autoantibody. Previous experimental studies have established MOG-IgG as a pathogenic antigen rather than an epiphenomenal bystander or a secon...
Source: Frontiers in Neurology - April 26, 2019 Category: Neurology Source Type: research

Decreased CSF Levels of ß-Amyloid in Patients With Cortical Superficial Siderosis
Conclusions: Our results demonstrate that the presence and extent of cSS are associated with reduced CSF ß-amyloid 42 levels. Further studies are needed to investigate the underlying mechanisms of this association. Introduction Cerebral amyloid angiopathy (CAA)—characterized by the deposition of ß-amyloid in the walls of leptomeningeal vessels—is a common cerebral small vessel disease and a major cause of intracerebral hemorrhage in the elderly (1–3). Furthermore, it has become evident that CAA is associated with cognitive impairment (4). Specifically, it has been shown that CAA patien...
Source: Frontiers in Neurology - April 26, 2019 Category: Neurology Source Type: research

A lot of nerve
A 71-year-old woman with a history of acute lymphoblastic leukemia presented with unilateral optic disc edema. Laboratory evaluations for infectious, inflammatory and neoplastic etiologies were negative. Magnetic resonance imaging of the orbits with and without contrast demonstrated enhancement and thickening of the right optic nerve with mild stranding of the intraconal fat. She underwent three large volume lumbar punctures which were negative for malignancy. An optic nerve biopsy was ultimately performed, demonstrating malignant cells on immunohistochemical staining. (Source: Survey of Ophthalmology)
Source: Survey of Ophthalmology - April 25, 2019 Category: Opthalmology Authors: Faith A. Birnbaum, Landon C. Meekins, Archana Srinivasan, Ann P. Murchison Tags: Short Reviews Source Type: research

Durable clinical benefit of letrozole in leptomeningeal metastasis of breast cancer
AbstractA case of a woman in her 60s with breast cancer, whose leptomeningeal metastasis (LM) of breast cancer improved remarkably with letrozole monotherapy, is reported. The patient complained of numbness of her left hand and hoarseness, followed by progressive asymmetric extremity weakness and a bladder and rectal disturbance. The patient had undergone surgery for left breast cancer 18  years earlier and was concerned about recurrence of breast cancer, but there were no typical findings with some imaging modalities. The third lumbar puncture showed the malignant cytology of breast cancer, and the patient was diagno...
Source: International Cancer Conference Journal - April 19, 2019 Category: Cancer & Oncology Source Type: research

Lumbar laminotomy for the intrathecal administration of nusinersen for spinal muscular atrophy: technical note and outcomes.
Abstract Nusinersen (Spinraza) is a US Food and Drug Administration-approved intrathecal medication for the treatment of spinal muscular atrophy (SMA). Adult patients with SMA often undergo thoracolumbar fusion to treat neurogenic scoliosis, preventing thecal access. The authors report a laminotomy technique and the ease of intrathecal access in three SMA patients with prior thoracolumbar fusions.Patients were positioned in the lateral decubitus position or prone. Lumbar laminotomy was performed below the conus, between the lateral longitudinal rods, to preserve mechanical stability. Fluoroscopy provided real-time...
Source: Journal of Neurosurgery.Spine - April 19, 2019 Category: Neurosurgery Authors: Ko D, Blatt D, Karam C, Gupta K, Raslan AM Tags: J Neurosurg Spine Source Type: research