Measurement of Choroid Thickness Using Optical Coherence Tomography to Monitor Intracranial Pressure in an Idiopathic Cranial Hypertension Model
Conclusion: Measurement of CT by OCT, which reflects ICP, allows for the follow-up of patients with IIH. In addition, it can be used to monitor other diseases with high ICP. (Source: Neurology India)
Source: Neurology India - July 6, 2020 Category: Neurology Authors: Ibrahim Ozdemir Serdar & #199;evik Source Type: research

Influence of procedural factors on patient procedural pain in relation to diagnostic lumbar puncture
The aim of this study is to investigate the influence of local anesthetic (LA), operator experience level and needle type on patient procedural pain in relation to diagnostic lumbar puncture (LP). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - July 4, 2020 Category: Emergency Medicine Authors: R.B.A. S ørensen, M.J.V. Henriksen, T. Wienecke Source Type: research

Figural Memory Impairment in Conjunction With Neuropsychiatric Symptoms in IgLON5 Antibody-Associated Autoimmune Encephalitis
ConclusionsOur findings broaden IgLON5 disease’s clinical spectrum to include predominant and discrete figural memory impairment together with sleeping dysfunction at disease onset. In addition, our report illustrates how important taking an elaborated diagnostic approach is to assuring an accurate diagnosis and the appropriate therapy if a patient presents with a persisting figural memory impairment and sleeping abnormalities so as to avoid overlooking IgLON5 disease and a potentially poor outcome. (Source: Frontiers in Psychiatry)
Source: Frontiers in Psychiatry - July 3, 2020 Category: Psychiatry Source Type: research

Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study
Conclusions: The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia (Source: Indian Journal of Anaesthesia)
Source: Indian Journal of Anaesthesia - July 1, 2020 Category: Anesthesiology Authors: Girija K Ballarapu Srinivasa R Nallam Aloka Samantaray V A Kiran Kumar Aditya P Reddy Source Type: research

Dopamine Metabolite Biomarkers and Testing for Disease Modification in Parkinson Disease —Reply
In Reply LeWitt correctly describes homovanillic acid (HVA) as an unreliable biomarker of Parkinson disease (PD) progression, but our study distinctively evaluated dopamine metabolism in response to nilotinib rather than a biomarker of PD progression, and participants were not taking monoamine oxidase B inhibitors. The hypothesis of this phase 2 study that nilotinib is a disease-modifying drug is based on previous animal data and explored a mix of biomarkers that included dopamine metabolism, α synuclein, and tau proteins. Methodologically, physiologically based population pharmacokinetics/pharmacodynamics studies sh...
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Dopamine Metabolite Biomarkers and Testing for Disease Modification in Parkinson Disease
To the Editor In their randomized, placebo-controlled clinical trial of nilotinib in patients with Parkinson disease (PD), Pagan and colleagues reported dopamine metabolite data as “exploratory biomarkers.” They describe these biochemical findings as providing support for studying nilotinib as a potential disease-modifying therapy. The reasons for their conclusions are largely based on changes in cerebrospinal fluid (CSF) homovanillic acid (HVA) and 3,4-dihydroxyphenylacet ic acid (DOPAC) concentrations (which, from my understanding of the data in Figure 2 A and B in the article, suggest that outlier effects mi...
Source: JAMA Neurology - June 29, 2020 Category: Neurology Source Type: research

Lumbar punctures and cerebrospinal fluid analysis
We describe how, with adequate preparation and correct patient positioning, the procedure can be performed quickly and safely. The range of investigations that can be performed on CSF and their interpretation are discussed. (Source: Medicine)
Source: Medicine - June 28, 2020 Category: Internal Medicine Authors: Catherine Morgan, Justin Pearson, Geraint Fuller Tags: Investigations in neurology Source Type: research

Cryptococcal meningitis: a review of cryptococcal antigen screening programs in Africa.
We describe the approach to the investigation of patients with cryptococcal antigenemia and the importance of lumbar puncture to identify individuals who may have cryptococcal meningitis in the absence of symptoms. The limitations of current treatment recommendations and the potential role of newly defined combination antifungal therapies are discussed. A literature review was conducted using a broad database search for cryptococcal antigen screening and related terms in published journal articles dating up to December 2019. Conference abstracts, publicly available guidelines and project descriptions were also incorporated...
Source: Expert Review of Anti-Infective Therapy - June 24, 2020 Category: Infectious Diseases Tags: Expert Rev Anti Infect Ther Source Type: research

Talaromyces (Penicillium) species infection in the central nervous system.
Authors: Chuah CH, Ong YC, Kong BH, Woo YY, Wong PS, Leong KN, Chow TS Abstract Talaromycosis typically occurs as an opportunistic infection among immunocompromised individuals. Infection caused by species other than T. marneffei is uncommon. While most reported cases describe infection in the lungs, we report an extremely rare intracranial Talaromyces species infection. This 61-year-old with end-stage renal disease who was unwell for the previous two months, presented with fever and worsening confusion lasting for three days. Lumbar puncture was suggestive of meningitis. Cerebrospinal fluid (CSF) culture was later...
Source: Journal of the Royal College of Physicians of Edinburgh - June 24, 2020 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research

A case of recurrent trimethoprim-sulfamethoxazole-induced aseptic meningitis and review of literature 
A case of recurrent trimethoprim-sulfamethoxazole-induced aseptic meningitis and review of literature
. Int J Clin Pharmacol Ther. 2020 Jun 22;: Authors: Corsini Campioli C, Stevens R, Suh G Abstract A 66-year-old male patient presented with fever, headache, mental status changes, and nuchal rigidity with a lumbar puncture revealing neutropenic pleocytosis, and a presumptive diagnosis of bacterial meningitis was made. A careful history revealed that symptoms started within hours of starting oral trimethoprim-sulfamethoxazole. Additional history uncovered a nearly identical episode 1 year earlier...
Source: International Journal of Clinical Pharmacology and Therapeutics - June 24, 2020 Category: Drugs & Pharmacology Tags: Int J Clin Pharmacol Ther Source Type: research

Cerebrospinal Fluid Hypovolemia and Posterior Reversible Encephalopathy Syndrome
We presented a case of PRES with CSF hypovolemia as a result of an inadvertent dural puncture and reviewed the literature to identify the clinical characterization and pathophysiological mechanism of PRES following CSF hypovolemia. A total of 31 cases of PRES-CSF hypovolemia was included for analysis. The median age was 33 years, with a notable female predominance (87.1%). Fifteen patients (48.4%) didn't have either a history of hypertension nor an episode of hypertension. The most common cause of CSF hypovolemia was epidural or lumbar puncture (n = 21), followed by CSF shunt (n = 6). The median interval between the proced...
Source: Frontiers in Neurology - June 23, 2020 Category: Neurology Source Type: research

Transverse venous sinus stenosis in idiopathic intracranial hypertension: a prospective pilot study.
CONCLUSIONS: Prospective examination of TVSS with serial magnetic resonance imaging in patients with IIH is feasible. TVSS in patients with IIH did not show any change, despite clinical improvement on medical management in all participants. PMID: 32589917 [PubMed - as supplied by publisher] (Source: Canadian Journal of Ophthalmology)
Source: Canadian Journal of Ophthalmology - June 23, 2020 Category: Opthalmology Authors: Chan W, Green AL, Mishra A, Maxner C, Shankar JJ Tags: Can J Ophthalmol Source Type: research

Atraumatic versus Conventional Needles for Lumbar Puncture.
Abstract Over 350,000 lumbar punctures (LP) are performed in acute care settings each year in the United States.1 Post-dural puncture headache (PDPH) is one of the most common complications after an LP, occurring in approximately 11% of patients,2 with one study reporting an occurrence rate of up to 36%.3 While PDPH has been attributed to multiple factors, needle tip design has been frequently investigated as a potential cause.2 It has been suggested conventional needles may cause larger lacerations in the dural fibers compared to atraumatic needles, increasing the degree of cerebrospinal fluid leakage.4 However, ...
Source: Accident and Emergency Nursing - June 22, 2020 Category: Emergency Medicine Authors: Gottlieb M, Long B Tags: Acad Emerg Med Source Type: research

Safety of bedside lumbar puncture in adult patients with thrombocytopenia
AbstractThe risk of lumbar puncture (LP) hemorrhagic complications is believed to be exacerbated by thrombocytopenia, yet evaluations in clinical practice are lacking. We conducted a retrospective cohort study to examine the risk of traumatic tap (TT) and significant hemorrhagic complications in thrombocytopenic patients undergoing bedside LP. Two hundred sixty-two adult patients undergoing initial bedside LP were analyzed. Overall, we observed 37 TTs (14.1%, 95% CI 10.0 to 18.3%). TTs occurred in 11 of 78 LPs performed on patients with thrombocytopenia, compared with 26 of 184 LPs among patients with a normal platelet cou...
Source: Annals of Hematology - June 20, 2020 Category: Hematology Source Type: research

Portex Lumbar Puncture Tray
No abstract available (Source: Biomedical Safety and Standards)
Source: Biomedical Safety and Standards - June 19, 2020 Category: Medical Devices Tags: RECALLS & FIELD CORRECTIONS—CLASS II Source Type: research

Recent cannabis use in HIV is associated with reduced inflammatory markers in CSF and blood
Conclusions Recent cannabis use was associated with lower levels of inflammatory biomarkers, both in CSF and blood, but in different patterns. These results are consistent with compartmentalization of immune effects of cannabis. The principal active components of cannabis are highly lipid soluble and sequestered in brain tissue; thus, our findings are consistent with specific anti-neuroinflammatory effects that may benefit HIV neurologic dysfunction. (Source: Neurology Neuroimmunology and Neuroinflammation)
Source: Neurology Neuroimmunology and Neuroinflammation - June 17, 2020 Category: Neurology Authors: Ellis, R. J., Peterson, S. N., Li, Y., Schrier, R., Iudicello, J., Letendre, S., Morgan, E., Tang, B., Grant, I., Cherner, M. Tags: HIV, Cerebrospinal Fluid Article Source Type: research

Management of Fever in Infants and Young Children.
Abstract Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal wh...
Source: American Family Physician - June 15, 2020 Category: Primary Care Authors: Hamilton JL, Evans SG, Bakshi M Tags: Am Fam Physician Source Type: research

Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting.
CONCLUSIONS: Jolt accentuation for headache may exclude diagnoses of meningitis in emergency settings, but high-quality evidence to support use of this test is lacking. Even where jolt accentuation of headache is negative, there is still the possibility of acute meningitis. This review identified the possibility of heterogeneity. However, factors that contribute to heterogeneity are incompletely understood, and should be considered in future research. PMID: 32524581 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 11, 2020 Category: General Medicine Authors: Iguchi M, Noguchi Y, Yamamoto S, Tanaka Y, Tsujimoto H Tags: Cochrane Database Syst Rev Source Type: research

Auxiliary Diagnostic Value of Tumor Markers in the Cerebrospinal Fluid and Blood for Leptomeningeal Metastasis from Non-small Cell Lung Cancer
Conclusion Our study demonstrates that Serum and CSF TM can work as an auxiliary clinical diagnostic tool, which has a potential value in early diagnosis of NSCLC patients with LM. Serial measurement of TM may play an important role in the clinical management of NSCLC patients with LM, which is worthy of further promotion and clinical application. DOI: 10.3779/j.issn.1009-3419.2020.103.09 (Source: Chinese Journal of Lung Cancer)
Source: Chinese Journal of Lung Cancer - June 10, 2020 Category: Cancer & Oncology Source Type: research

Caliber of lumbar puncture needle in preterm infants: few concerns
(Source: European Journal of Pediatrics)
Source: European Journal of Pediatrics - June 8, 2020 Category: Pediatrics Source Type: research

Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis.
Conclusion: The most common pathogens of meningitis were Klebsiella pneumoniae and Enterobacter aerogenes. Respiratory symptoms were the most common clinical signs, and laboratory symptoms included increased CRP, increased leukocytes and proteins in CSF. PMID: 32494342 [PubMed] (Source: Iranian Journal of Microbiology)
Source: Iranian Journal of Microbiology - June 6, 2020 Category: Microbiology Tags: Iran J Microbiol Source Type: research

Cryptococcal meningitis in an immunocompetent patient
Cryptococcal meningitis is a fungal infection that is most commonly thought of as an opportunistic infection affecting immunocompromised patients, classically patients with Human Immunodeficiency (HIV) infection. It is associated with a variety of complications including disseminated disease as well as neurologic complications including intracranial hypertension, cerebral infarcts, vision loss and other neurologic deficits. It is diagnosed by lumbar puncture with CSF studies, including fungal culture and cryptococcal antigen testing. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - June 5, 2020 Category: Emergency Medicine Authors: Laura S. Murphy, Aaron J. Lacy, Austin T. Smith, Karan S. Shah Source Type: research

Development of a Lumbar Drain Simulator for Instructional Technique and Skill Assessment
ConclusionsA high-fidelity lumbar drain simulator can be constructed in a cost-effective manner. We have detailed the materials and assembly of our successful design in order to provide a novel educational tool for procedural instruction and practice. (Source: Neurocritical Care)
Source: Neurocritical Care - June 1, 2020 Category: Neurology Source Type: research

Management of postdural puncture headache in pediatric using an epidural catheter for an epidural blood patch
We report the case of an 8-year-old child suspected to have postdural puncture headache after multiple lumbar punctures for collection of cerebrospinal fluid for analysis. His symptoms included headache, nonprojectile vomiting, and lethargy. When conservative management failed, an epidural blood patch was applied and the depth of the epidural space was determined using MRI. Epidural blood patch treatment was successful, and an epidural catheter was left in situ, in case a second patch was required. (Source: Saudi Journal of Anaesthesia)
Source: Saudi Journal of Anaesthesia - May 30, 2020 Category: Anesthesiology Authors: Adnan Al Wosaibai Ahmed Alfaraj Abduladem K Alshabeb Source Type: research

Implantable Sensor for Detecting Changes in the Loss Tangent of Cerebrospinal Fluid
The increasing utilization of cerebrospinal fluid (CSF) in early detection of Alzheimer’s disease (AD) is attributed to the change of Amyloid-$beta$ proteins. Since, the brain is suspended in CSF, changes of Amyloid-$beta$ proteins in CSF reflect a pathophysiological variation of the brain due to AD. However, the correlation between Amyloid-$beta$ proteins and the dielectric properties (DPs) of CSF is still an open question. This paper reports the characterized DPs of CSF collected from canines using lumbar punctures. The CSF samples from canines show a strong correlation with respect to human in terms of the loss ta...
Source: IEEE Transactions on Biomedical Circuits and Systems - May 29, 2020 Category: Biomedical Engineering Source Type: research

Lower Glucose Level Associated With Increased Risk for Post-Dural Puncture Headache.
CONCLUSIONS: Low glucose levels were inversely associated with risk for post-dural puncture headache. Patients with low serum glucose should be carefully monitored for headache after lumbar puncture. PMID: 32463126 [PubMed - as supplied by publisher] (Source: Headache)
Source: Headache - May 28, 2020 Category: Neurology Authors: Hwang J, Lim YH, Eun MY, Jeon JY, Ko PW, Kim SH, Kang K, Lee HW, Park JS Tags: Headache Source Type: research

An update on idiopathic intracranial hypertension in adults: a look at pathophysiology, diagnostic approach and management
AbstractIdiopathic intracranial hypertension is a neurological syndrome determined by a rise in intracranial pressure without a detectable cause. Course and prognosis may be changeable, requiring a multidisciplinary approach for its diagnosis and management. Although its precise pathogenesis is still unknown, many studies have been carried out to define the possible causal and associated factors, such as retinoids, steroid hormones, body mass index and recent weight gains, cytokines and adipokines levels. The clinical presentation can be variable including chronic headache, disturbance of vision, diplopia and tinnitus. Eve...
Source: Journal of Neurology - May 27, 2020 Category: Neurology Source Type: research

Ventral Displacement of Spinal Cord in Spontaneous Intracranial Hypotension: A Sign Easily Be Overlooked.
CONCLUSION: We review the typical and uncommon findings of spinal MRI in SIH, which is more sensitive than brain MRI in acute stages. Spinal MRI offers the diagnostic value in SIH especially when cranial images do not respond in time. PMID: 32436204 [PubMed - in process] (Source: Acta Neurologica Taiwanica)
Source: Acta Neurologica Taiwanica - May 23, 2020 Category: Neurology Tags: Acta Neurol Taiwan Source Type: research

Nusinersen injections in adults and children with spinal muscular atrophy: a single-center experience.
CONCLUSION: With the introduction of nusinersen treatment, neurologists and radiologists play an important role in treatment of SMA patients and therefore should be familiar with different techniques and complications of drug administration. Using good technique, it is possible to have very low complication rates even in this complex patient population, and various image-guided procedures can be a safe alternative to surgical approach, even in the most difficult cases. PMID: 32436843 [PubMed - as supplied by publisher] (Source: Diagnostic and Interventional Radiology : The Turkish Society of Radiology)
Source: Diagnostic and Interventional Radiology : The Turkish Society of Radiology - May 21, 2020 Category: Radiology Authors: Özütemiz C, Karachunski P, R Nascene D Tags: Diagn Interv Radiol Source Type: research

Circum-zygomatic suspension wiring using lumbar puncture needle: A technical note
KR Ashok Kumar, Supriyo Pal, Ravi KumarIndian Journal of Dental Research 2020 31(2):331-333 In the treatment of mid-facial fractures circum-zygomatic suspension wiring is one of the treatment modality. Earlier zygomatic awls were used to pass wire, which used to cause conspicuous trauma. In the present case we have used 16 gauge lumbar puncture needle for the suspension wiring for Lefort 1 fracture, which is inconspicuous as compared to an awl. The needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue, and the wire was twiste...
Source: Indian Journal of Dental Research - May 19, 2020 Category: Dentistry Authors: KR Ashok Kumar Supriyo Pal Ravi Kumar Source Type: research

Update in Pediatric Pseudotumor Cerebri Syndrome
Semin Neurol DOI: 10.1055/s-0040-1708847Pseudotumor cerebri syndrome (PTCS) is a rare condition in children presenting with headache and papilledema from increased intracranial pressure that can cause significant morbidity. This can be idiopathic, also known as idiopathic intracranial hypertension or primary intracranial hypertension, or can be secondary to medications and associated medical conditions. Given the threat to vision, early detection and treatment is needed in all age groups. However, identifying papilledema or pseudopapilledema in children presents unique challenges sometimes as a result of differences betwee...
Source: Seminars in Neurology - May 18, 2020 Category: Neurology Authors: Beres, Shannon J. Tags: Review Article Source Type: research

Idiopathic Intracranial Hypertension: Contemporary Management and Endovascular Techniques
Semin intervent Radiol 2020; 37: 175-181 DOI: 10.1055/s-0040-1709172Idiopathic intracranial hypertension (IIH) is a disease process of abnormally increased intracranial pressure in the absence of a mass lesion. Medical management, optic nerve fenestration, and surgical shunting procedures have failed to produce consistently successful results. In an unknown percentage of cases, IIH is caused by dural venous sinus obstruction which can be cured by endovascular treatment with dural venous sinus stent placement. This helps prevent progressive vision loss and worsening papilledema caused by underlying increased intracranial pr...
Source: Seminars in Interventional Radiology - May 14, 2020 Category: Radiology Authors: Case, David Seinfeld, Joshua Roark, Christopher Kumpe, David Tags: Review Article Source Type: research

Spinal needle size and traumatic neonatal lumbar puncture: an observational study (neo-LP)
AbstractThe incidence of ‘traumatic’ lumbar puncture (LP; CSF red cells>  500/mm) has been reported to be 35–46% in the neonatal period. A traumatic LP incurs challenges in diagnosis and management of the underlying condition and increases the risk of complications. We aimed to assess the benefits of a smaller outer diameter, larger gauge 25G needle in reducing the i ncidence of traumatic LPs compared with the standard 22G LP needle. This prospective observational study compared data from two consecutive epochs. Epoch 1 (Control, April 2016–October 2016), 22G needle for LP as standard prac...
Source: European Journal of Pediatrics - May 13, 2020 Category: Pediatrics Source Type: research

Lumbar Puncture
Present your spine to the resident (Source: Anesthesiology)
Source: Anesthesiology - May 13, 2020 Category: Anesthesiology Source Type: research

Ultrasound measurement of optic nerve sheath diameter pre- and post-lumbar puncture
AbstractBackgroundTo test the hypothesis that optic nerve sheath diameter (ONSD) correlates with real-time changes in intracranial pressure, we performed ultrasound measurements of the ONSD in ambulatory patients undergoing elective lumbar puncture (LP). We conducted a prospective cohort study, including adult patients undergoing LP in a non-emergent setting. We measured ONSD perpendicular to the optic nerve at 3  mm behind the globe in both eyes in the traverse and sagittal planes, with the patient supine. The primary outcome was change in ONSD from pre-LP to post-LP. We calculated association of opening and closing ...
Source: Critical Ultrasound Journal - May 13, 2020 Category: Radiology Source Type: research

Hemifacial Spasm as a Rare Clinical Presentation of Idiopathic Intracranial Hypertension: Case Report and Literature Review.
CONCLUSION: HFS may be a rare presenting manifestation of IIH, and treatment of IIH may result in improvement of HFS symptoms. This is the first report of IIH presenting with HFS in the absence of headache or visual change. As a result, this is the first report of HFS as a presenting manifestation of IIH in Otolaryngology literature. PMID: 32390451 [PubMed - as supplied by publisher] (Source: The Annals of Otology, Rhinology, and Laryngology)
Source: The Annals of Otology, Rhinology, and Laryngology - May 11, 2020 Category: ENT & OMF Authors: Poff CB, Lipschitz N, Kohlberg GD, Breen JT, Samy RN Tags: Ann Otol Rhinol Laryngol Source Type: research

Intracerebral hematoma at the basal ganglia following lumbar puncture
We present a patient who developed hematoma in the basal ganglia following LP. (Source: Journal of Stroke and Cerebrovascular Diseases)
Source: Journal of Stroke and Cerebrovascular Diseases - May 7, 2020 Category: Neurology Authors: Unal Ozturk, P ınar Aydin Ozturk, Ahmet Adiguzel Tags: Case Report Source Type: research

Visual changes after space flight: is it really caused by increased intracranial tension? A systematic review.
CONCLUSIONS: Exposure to microgravity increases ICP possibly precipitating ocular changes. Whether other factors come into play is the subject of investigation. Further randomized studies and methods of direct ICP measurement during spaceflight are needed. PMID: 32347675 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgical Sciences)
Source: Journal of Neurosurgical Sciences - May 1, 2020 Category: Neurosurgery Tags: J Neurosurg Sci Source Type: research

Post-dural puncture headache incidence after cerebrospinal fluid aspiration. A prospective observational study
Abstract Background: Post-dural puncture headache (PDPH) is an iatrogenic condition following lumbar puncture (LP). Incidence is variable and often associated with young females. Technical features of the procedure (i.e. needle gauge) have been investigated; however there is no investigation on the method of cerebrospinal fluid (CSF) collection. Objective: To investigate whether mild CSF aspiration is associated with increased PDPH in selected patients. Methods: 336 subjects were eligible to the study. Data on 237 patients from a tertiary neurology hospital who underwent diagnostic LP from February 2010 to December 2012 we...
Source: Arquivos de Neuro-Psiquiatria - May 1, 2020 Category: Neurology Source Type: research

Analgesia for spinal anesthesia positioning in elderly patients with proximal femoral fractures: Dexmedetomidine-ketamine versus dexmedetomidine-fentanyl
Elderly patients with femoral fractures are anticipated to endure the most pain caused by positional changes required for spinal anesthesia. To improve pain relief, we compared the analgesic effects of intravenous dexmedetomidine-ketamine and dexmedetomidine-fentanyl combinations to facilitate patient positioning for spinal anesthesia in elderly patients with proximal femoral fractures. Forty-six patients were randomly assigned to two groups and received either 1 mg/kg of intravenous ketamine (group K) or 1 μg/kg of intravenous fentanyl (group F) concomitant with a loading dose of dexmedetomidine 1 μg/kg over...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Straight to the point: an updated technique for performing lumbar puncture safely in obese patients
. (Source: British Journal of Neurosurgery)
Source: British Journal of Neurosurgery - April 30, 2020 Category: Neurosurgery Authors: Amad Khan Nilesh Mundil Source Type: research

Evidence of retinal anterograde neurodegeneration in the very early stages of multiple sclerosis: a longitudinal OCT study
ConclusionsAt very early clinical stages, mGCIPL thickness values were reduced without a concomitant peripapillary RNFL thinning. The longitudinal assessment demonstrated a RNFL loss in patients compared to HC, together with a plateau of mGCIPL thinning. A βlow subgroup of patients showed a reduction of retinal nerve fiber layer thickness. (Source: Neurological Sciences)
Source: Neurological Sciences - April 30, 2020 Category: Neurology Source Type: research

Reactive increase of cerebrospinal fluid white blood cell count after lumbar puncture: Fact or fiction?
Lumbar puncture (LP) is commonly used in the diagnostic workup of neurological patients, often to exclude inflammatory diseases of the central nervous system. In clinical practice, an increase of white blood cell count (WBC) in the cerebrospinal fluid (CSF) after a LP is often assumed as reactive to the first puncture. Scientific evidence of this hypothesis, however, is lacking.Retrospective review of laboratory parameters obtained by analyzing CSF of patients who had at least two LPs between 2012 and 2016. (Source: Journal of the Neurological Sciences)
Source: Journal of the Neurological Sciences - April 30, 2020 Category: Neurology Authors: Bernhard Neumann, Tim Steinberg, De-Hyung Lee, Johanna Kress, Marco Kufner, Felix Schlachetzki, Georg Weinfurtner, Ralf Linker, Klemens Angstwurm Tags: Clinical Short Communication Source Type: research

Acute flaccid paralysis as the initial manifestation of Japanese encephalitis: a case report.
Abstract Japanese encephalitis (JE) is an inflammation of the central nervous system resulting in clinical disease, with symptoms ranging broadly in severity from mild febrile illness to acute meningomyeloencephalitis. JE has been associated with a variety of neurological abnormalities such as altered sensorium, seizures, focal neurological deficit, and acute flaccid paralysis (AFP). However, AFP has never been reported as the initial manifestation of JE. Here we present a case of AFP as the initial manifestation of JE in a Chinese patient. A 30-year-old Chinese man was admitted to West China Hospital of Sichuan U...
Source: Japanese Journal of Infectious Diseases - April 30, 2020 Category: Infectious Diseases Authors: Shen Q, Li Y, Lu H, Ning P, Huang H, Zhao Q, Xu Y Tags: Jpn J Infect Dis Source Type: research

Pioneers in the cisterna magna puncture
Abstract At the beginning of the 20th century, cerebrospinal fluid (CSF) collection and analysis emerged as a promising aid in the diagnosis of diseases of the central nervous system. It was obtained through the established procedure of lumbar puncture, described by Heinrich Quinke in 1891. The search for an alternative way to gather the CSF emerged in animal research, highlighting the cisterna magna as a promising source, with relative safety when performed by someone trained. Described initially and in detail by James Ayer in 1920, the procedure was widely adopted by neurologists and psychiatrists at the time, featuring ...
Source: Arquivos de Neuro-Psiquiatria - April 27, 2020 Category: Neurology Source Type: research

A Case of Clinical Scholarship
A 32-year-old child and adolescent psychiatry resident with a history of presenting an abstract at a local psychiatric conference during residency and fourth authorship on an immunotherapy paper from a summer internship during medical school presents with a new-onset desire to write a case report. She has just come off her consultation liaison rotation, during which she consulted on a 12-year-old boy with attention-deficit/hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, and low depressive state hospitalized for pseudoseizures, a new-onset inability to walk, and aggressive outb...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - April 24, 2020 Category: Psychiatry Authors: Schuyler W. Henderson Tags: Commentary Source Type: research

Evidence for communication of peripheral iron status to cerebrospinal fluid: clinical implications for therapeutic strategy
ConclusionsThe clinical ramifications of these findings are several- fold. They suggest that erythropoietic demands for iron take precedence over brain requirements, and that the metric traditionally considered to be the most specific test reflecting total body iron stores and relied upon to inform treatment decisions –i.e., serum ferritin –may not be the preferred peripheral indicator when attempting to promote brain iron uptake. The future direction of this line of investigation is to identify the factor(s) in the CSF that influence iron transport at the level of the BBB. (Source: Fluids and Barriers of the CNS)
Source: Fluids and Barriers of the CNS - April 16, 2020 Category: Neuroscience Source Type: research

Study protocol: NeoCLEAR: Neonatal Champagne Lumbar punctures Every time – An RCT: a multicentre, randomised controlled 2 × 2 factorial trial to investigate techniques to increase lumbar puncture success
The neonatal period carries the highest risk of bacterial meningitis (~  1 in 5000 births), bearing high mortality (~ 10%) and morbidity (20–50%) rates. Lumbar puncture (LP) remains essential to the diagnosis o... (Source: BMC Pediatrics)
Source: BMC Pediatrics - April 15, 2020 Category: Pediatrics Authors: Andrew S. J. Marshall, Manish Sadarangani, Alexandra Scrivens, Rachel Williams, Jean Yong, Ursula Bowler, Louise Linsell, Virginia Chiocchia, Jennifer L. Bell, Caz Stokes, Patricia Santhanadass, Eleri Adams, Edmund Juszczak and Charles C. Roehr Tags: Study protocol Source Type: research

Isolated De Novo Headache as the Presenting Symptom of Listeria Meningitis: A Report of 2 Cases.
CONCLUSIONS: Listeria meningitis may present as an isolated headache, with different clinical patterns, which should be taken into account when evaluating de novo unclassified headaches according to the ICHD-3 criteria. PMID: 32282065 [PubMed - as supplied by publisher] (Source: Headache)
Source: Headache - April 13, 2020 Category: Neurology Authors: Pérez-Pereda S, González-Quintanilla V, Toriello-Suárez M, de Malet Pintos-Fonseca A, Sánchez Rodríguez A, Gallo Valentín D, Pascual J Tags: Headache Source Type: research

Comparison of High-Dose Intracisterna Magna and Lumbar Puncture Intrathecal Delivery of AAV9 in Mice to Treat Neuropathies.
We report that an intrathecal gene delivery of AAV9 in mice leads to stable transduction of neurons and glia in the brain and spinal cord and has a widespread distribution that includes components of the PNS. Vector expression was notably higher in select brain and PNS regions following ICM injection, while higher amounts of vector was found in the lower spinal cord and peripheral organs following LP injection. These findings support that intrathecal AAV9 delivery is a translationally relevant delivery method for inherited neuropathies. PMID: 32289279 [PubMed - as supplied by publisher] (Source: Brain Research)
Source: Brain Research - April 11, 2020 Category: Neurology Authors: Bailey RM, Rozenberg A, Gray SJ Tags: Brain Res Source Type: research