Multicenter Experience with Nusinersen Application via an Intrathecal Port and Catheter System in Spinal Muscular Atrophy
Neuropediatrics DOI: 10.1055/s-0040-1715481Nusinersen, an antisense oligonucleotide enhancing the production of the survival motor neuron protein, is approved for the treatment of spinal muscular atrophy (SMA) but requires repetitive lumbar punctures. Application via a subcutaneous port connected to a permanent intrathecal catheter has been proposed as an alternative for patients with severe scoliosis, spinal fusion, or comorbidities, rendering serial interlaminar punctures complicated and risky. Since experience with this technique is sparse and follow-up data are lacking, we assessed feasibility, safety, and tolerability...
Source: Neuropediatrics - October 22, 2020 Category: Neurology Authors: Flotats-Bastardas, Marina Hahn, Andreas Schwartz, Oliver Linsler, Steffan Meyer, Sascha Kolodziej, Malgorzata Koehler, Cornelia Tags: Original Article Source Type: research

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature
We present the case of an intradural hematoma after an extraforaminal surgery through the Wiltse approach for an extraforaminal disk herniation at L5/S1. This 58-year-old woman experienced hypoesthesia and progressive motor dysfunction in the left leg several hours postoperation. Urgent magnetic resonance imaging revealed an intradural hematoma at the L1/L2 to L2/L3 level in the ventral dural sac proximal to the surgical level. Surgical decompression was performed. There was no evidence of trauma, coagulopathy, or anticoagulation therapy. To our knowledge, this case is the first to report an acute sSDH proximal to the surg...
Source: Journal of Neurological Surgery Part A: Central European Neurosurgery - October 21, 2020 Category: Neurosurgery Authors: Raymaekers, Vincent Beck, Tobias Goebel, Svenja Janssens, Femke Van den Branden, Lien Menovsky, Tomas Plazier, Mark Tags: Case Report Source Type: research

Spontaneous Intracranial Hypotension.
CONCLUSION: The management of patients with SIH calls for complementary imaging studies to demonstrate the causative spinal CSF leak. Often, successful treatment requires surgical closure of the leak. In view of the sparse evidence available to date, controlled studies should be performed. PMID: 33050997 [PubMed - as supplied by publisher] (Source: Deutsches Arzteblatt International)
Source: Deutsches Arzteblatt International - October 20, 2020 Category: General Medicine Tags: Dtsch Arztebl Int Source Type: research

Does post dural puncture headache exist in idiopathic intracranial hypertension? A pilot study.
CONCLUSION: PDPH can occur after LP in IIH patients. Clinicians should be aware of this possible event during the IIH diagnosis assessment and should not automatically reconsider IIH diagnosis. PDPH prevention using an atraumatic needle and dedicated PDPH treatment seem relevant in IIH patients. PMID: 33069377 [PubMed - as supplied by publisher] (Source: Revue Neurologique)
Source: Revue Neurologique - October 20, 2020 Category: Neurology Tags: Rev Neurol (Paris) Source Type: research

Complete bilateral ophthalmoplegia in malignant intracranial hypertension in a child.
CONCLUSION: The authors believe that the acute, severe, and fulminant ("malignant") presentation with markedly elevated intracranial pressure may produce the unique presentation of severe vision loss and bilateral complete ophthalmoplegia. Interestingly, there was no headache. To our knowledge this is the first such case to be reported in the English language ophthalmic literature. PMID: 33081535 [PubMed - as supplied by publisher] (Source: European Journal of Ophthalmology)
Source: European Journal of Ophthalmology - October 20, 2020 Category: Opthalmology Authors: Interlandi E, Pellegrini F, De Luca M, Cerullo G, De Falco A, De Marco R, Tortori A, Lee AG Tags: Eur J Ophthalmol Source Type: research

Declines in the number of Lumbar Punctures performed at U.S. Children ’s Hospitals: 2009-2019
to evaluate trends in LP performance among U.S. children ’s hospitals to assess how risk stratification algorithms impact pediatric resident trainee exposure to lumbar puncture (LP). (Source: The Journal of Pediatrics)
Source: The Journal of Pediatrics - October 17, 2020 Category: Pediatrics Authors: Alexandra T. Geanacopoulos, John J. Porter, Kenneth A. Michelson, Rebecca S. Green, Vincent W. Chiang, Michael C. Monuteaux, Mark I. Neuman Tags: Original Articles Source Type: research

Pathogen identification in culture-negative cerebrospinal fluid specimens of patients with purulent meningitis using next-generation sequencing technology.
Abstract Antimicrobial therapy necessitates fast and accurate detection of pathogens in purulent meningitis (PM) diagnosis. Although considered a gold standard, the traditional bacterial detection and identification methods based on routine bacterial culture are time-consuming and show low sensitivity and specificity. In order to reduce PM-related deaths and improve the treatment efficiency, we employed trace DNA extraction technology and combined it with Next-Generation Sequencing technology for bacteria identification. We extracted DNA from 31 cerebrospinal fluid (CSF) samples from people with PM. The samples we...
Source: International Journal of Clinical and Experimental Pathology - October 14, 2020 Category: Pathology Authors: Men X, Zhao G, Zhao W, Zhang J, Yang Y, Chen C Tags: Int J Clin Exp Pathol Source Type: research

Association of Lumbar Puncture With Spinal Hematoma in Patients With and Without Coagulopathy
This cohort study uses Danish registry data to assess the risk of spinal hematoma following lumbar puncture in patients with vs without coagulopathy (platelets1.4, or APTT>39 seconds). (Source: JAMA)
Source: JAMA - October 13, 2020 Category: General Medicine Source Type: research

In NPH, setting valve opening pressure close to lumbar puncture opening pressure decreases overdrainage.
CONCLUSION: We propose that the initial VOP should be set as close as possible to the patient's LPOP to decrease overdrainage without compromising symptom improvement. PMID: 33047786 [PubMed - as supplied by publisher] (Source: Neurologia i Neurochirurgia Polska)
Source: Neurologia i Neurochirurgia Polska - October 13, 2020 Category: Neurology Authors: Vivas-Buitrago T, Domingo R, Tripathi S, Herrera JP, Heemskerk J, Grewal S, Zalewski NL, Quinones-Hinojosa A, Reimer R, Wharen RE, Graff-Radford NR Tags: Neurol Neurochir Pol Source Type: research

Transient blindness associated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS): a case report and review of literature
ConclusionTransient blindness was reported as an initial symptom of MERS in a few children. To date, there is no evidence of effective treatment methods. Nonetheless, MERS diagnosis provides pediatricians with valuable prognostic information in order to reassure patients and their families about the good outcome of this disease. (Source: Italian Journal of Pediatrics)
Source: Italian Journal of Pediatrics - October 12, 2020 Category: Pediatrics Source Type: research

Occurrence of postdural puncture headache —A randomized controlled trial comparing 22G Sprotte and Quincke
ConclusionsThe use of 22GS halves the risk of PDPH compared with 22GQ. This study provides strong support to make a change in practice where traumatic needles are still in regular use. (Source: Brain and Behavior)
Source: Brain and Behavior - October 12, 2020 Category: Neurology Authors: Ane Skaare Sjulstad, Francis Odeh, Farid K. Baloch, Diana Hristova Berg, Kathrine Arntzen, Karl B. Alstadhaug Tags: ORIGINAL RESEARCH Source Type: research

Intramedullary pneumorrhachis following a cervical epidural steroid injection.
Abstract Pneumorrhachis (PR) is a rare radiological condition characterized by the presence of intraspinal air. PR is commonly classified as spontaneous (nontraumatic), traumatic, or iatrogenic, and iatrogenic PR is the most common and often occurs secondary to invasive procedures such as epidural anesthesia, lumbar puncture, or spinal surgery. PR is usually asymptomatic, but it can produce symptoms associated with its underlying pathology. Here, we report a rare case of intramedullary cervical PR following a cervical epidural steroid injection (ESI) and include pertinent discussion. PMID: 33049286 [PubMed - ...
Source: Neuro-Chirurgie - October 10, 2020 Category: Neurosurgery Authors: Han HJ, Wook KJ, Ho JJ Tags: Neurochirurgie Source Type: research

Relapsing-Remitting Hepatic Pseudo-Cyst: a great simulator of malfunctioning ventriculoperitoneal shunt. Case report and proposal of a new classification.
CONCLUSION: Based on current literature we propose a clinical and radiological classification of such pseudocysts related to ventriculoperitoneal shunt. Clinical presentation, diagnostic findings and management options are proposed for each type: purely infective, spurious (infective/inflammatory) and purely inflammatory. In the absence of system infection, a simple replacement of the distal catheter seems to be the best solution. PMID: 33049283 [PubMed - as supplied by publisher] (Source: Neuro-Chirurgie)
Source: Neuro-Chirurgie - October 10, 2020 Category: Neurosurgery Authors: Mallereau CH, Ganau M, Todeschi J, Addeo PF, Moliere S, Chibbaro S Tags: Neurochirurgie Source Type: research

Validity evidence of a task trainer for normal and difficult lumbar puncture: A cross-sectional study
This study aims to evaluate evidence for construct and content validity of 4 interchangeable lumbar puncture (LP) complex anatomic configurations of this simulator. We performed a cross-sectional study between April 2018 and May 2019. Novice volunteer medical students and expert physicians who had performed over 30 LP procedures performed sequential LP procedures on each of 4 simulated interchangeable anatomic LP puncture blocks (normal, obesity, geriatric, combined geriatric/obesity). Primary outcome measures compared between groups for each LP procedure were return of cerebrospinal fluid within 5 minutes and a calculate...
Source: Medicine - October 9, 2020 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Educational intervention with serial album about pregnant women positioning for spinal anesthesia: randomized clinical trial.
CONCLUSION: Educational intervention with serial album was effective and contributed to immobility and positioning of pregnant women. Brazilian Registry of Clinical Trials (RBR-3Z7SRD). PMID: 33027488 [PubMed - as supplied by publisher] (Source: Revista Brasileira de Enfermagem)
Source: Revista Brasileira de Enfermagem - October 8, 2020 Category: Nursing Authors: Pinto SL, Sampaio LA, Galindo Neto NM, Almeida PC, Oliveira MF, Caetano JÁ Tags: Rev Bras Enferm Source Type: research

Dual antiretroviral therapies are effective and safe regimens in the central nervous system of neurologically symptomatic people living with HIV
Conclusion: In people living with HIV with neurological/neurocognitive symptoms, peripherally effective dual therapy can show CSF virosuppression, inflammation, neuronal and astrocyte integrity and neurocognition comparable to triple therapy. (Source: AIDS)
Source: AIDS - October 6, 2020 Category: Infectious Diseases Tags: CLINICAL SCIENCE Source Type: research

What did he eat?
A 13-year-old boy reported acute horizontal binocular diplopia and headache. Ten days prior to these symptoms, he suffered from a gastrointestinal infection. Ophthalmological examination revealed bilateral ophthalmoparesis and diffuse hyporeflexia. Magnetic resonance imaging of the brain was normal. Lumbar puncture revealed albumin-cytological dissociation. There were no anti-GQ1b antibodies, but serum anti-GM1 antibodies were raised. He received intravenous immunoglobulins and had fully recovered two weeks later. (Source: Survey of Ophthalmology)
Source: Survey of Ophthalmology - September 29, 2020 Category: Opthalmology Authors: S. Rodrigo-Rey, C. Guti érrez-Ortiz, S. Muñoz, J.V. Ortiz-Castillo, R.M. Siatkowski Source Type: research

[Material and sedation-analgesia in the neonatal lumbar puncture procedure].
CONCLUSIONS: Currently, the LP procedure in the neonatal period is mainly performed with a trocar needle with a stylet and with the widespread use of different analgesic measures. PMID: 32998845 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)
Source: Anales de Pediatria - September 26, 2020 Category: Pediatrics Authors: Jimeno Ruiz S, Riaza Gómez M, Cárdenas Rebollo JM, López-Escobar A Tags: An Pediatr (Barc) Source Type: research

Lumbar Puncture Increases Risk of Lumbar Degenerative Disc Disease: Analysis From the Rochester Epidemiology Project
No abstract available (Source: Spine)
Source: Spine - September 25, 2020 Category: Orthopaedics Tags: EPIDEMIOLOGY Source Type: research

Platelet count threshold for lumbar puncture: Does one size really fit all?
PMID: 32978805 [PubMed - as supplied by publisher] (Source: Transfusion)
Source: Transfusion - September 24, 2020 Category: Hematology Authors: Eşkazan AE Tags: Transfusion Source Type: research

Recurrent branch retinal artery occlusion from susac syndrome: case report and review of literature
Conclusion: It is a diagnostic challenge when recurrent branch retinal artery occlusion secondary to Susac syndrome presents without the classic symptoms. Optical coherence tomography angiography and subtle magnetic resonance imaging findings aided in early recognition of the diagnosis in our patient. Ultra-wide-field fluorescein angiography was an important tool in disease monitoring. Aggressive management with intravenous corticosteroids and initiation of immunosuppression resulted in long-term preservation of vision and improvement in visual field. (Source: Retinal Cases and Brief Reports)
Source: Retinal Cases and Brief Reports - September 22, 2020 Category: Opthalmology Tags: Case Report Source Type: research

Lower CSF Homovanillic Acid Relates to Higher Burden of Neuroinflammation and Depression in People with HIV Disease.
CONCLUSIONS: Results suggest that the pathophysiology of depression in PWH differs from that in HIV- individuals. Specifically, lower central dopaminergic activity was selectively associated with greater depressive symptoms and neuroinflammation in PWH. With the rise in consideration of DA agonists for the treatment of depression, these results suggest that PWH may show a greater response to these agents than their HIV- peers. PMID: 32966871 [PubMed - as supplied by publisher] (Source: Brain, Behavior, and Immunity)
Source: Brain, Behavior, and Immunity - September 19, 2020 Category: Neurology Authors: Saloner R, Cherner M, Grelotti DJ, Paolillo EW, Moore DJ, Heaton RK, Letendre SL, Kumar A, Grant I, Ellis RJ Tags: Brain Behav Immun Source Type: research

Editorial
The Dorsal Column of this issue ofBrain features a perspective by Bart Lutters and Peter Koehler that looks back at the history of cisterna magna puncture, a procedure that was first described in detail by James Bourne Ayer in 1920. They point out that adoption of the technique was driven, to a great extent, by the goal of delivering therapeutic agents directly to the CNS, and that its popularity waned as antibiotics that could be administered intramuscularly or intravenously replaced intrathecal anti-meningococcal serum, arsphenamine and ‘salvarsanized’ serum (a cocktail of arsphenamine and the patient’s...
Source: Brain - September 18, 2020 Category: Neurology Source Type: research

Facial nerve paralysis caused by a T ‐cell lymphoma
Facial nerve paralysis due to the infiltration by a lymphoma is rare and the prognosis remains poor. If perineural spread and meningeosis are suspected, quick interdisciplinary diagnostic work ‐up is recommended. It should include magnetic resonance imaging, biopsy of the lesion, bone marrow biopsy, and lumbar puncture. Therapy should be initiated immediately. Key Clinical MessageFacial nerve paralysis due to the infiltration by a lymphoma is rare and the prognosis remains poor. If perineural spread and meningeosis are suspected, quick interdisciplinary diagnostic work ‐up is recommended. It should include magnetic res...
Source: Clinical Case Reports - September 14, 2020 Category: General Medicine Authors: Lisa Nachtsheim, Maike Wittersheim, Stefanie Kreissl, Jens Peter Klussmann, Maria Grosheva Tags: CASE REPORT Source Type: research

A case of mistaken identity: An unusual presentation of neoplastic meningitis and a reminder of the hallmark features
This case offers an opportunity for education on the manifestations of neoplastic meningitis, a revision of the hallmark investigative features, and a reminder of the utilization of lumbar puncture in investigating unexplained neurological symptoms. Additionally, it emphasises the need for clinicians to avoid "diagnostic anchoring" when faced with recurrent attenders. AbstractThis case offers an opportunity for education on the manifestations of neoplastic meningitis, a revision of the hallmark investigative features, and a reminder of the utilization of lumbar puncture in investigating unexplained neurological s...
Source: Clinical Case Reports - September 14, 2020 Category: General Medicine Authors: Catriona Davidson, Katerina Achilleos, Francesca Crawley, William Petchey Tags: CASE REPORT Source Type: research

Peripapillary microperimetry for the diagnosis and follow-up of papilledema in cases treated for idiopathic intracranial hypertension.
This study was a prospective non-comparative observational case series of patients with IIH. All patients underwent full ophthalmological examination, radiological imaging, and lumbar puncture, as well as microperimetric measurements around the optic nerve head. Patients were classified into a medical group, treated by weight reduction and acetazolamide, and a surgical group, treated by optic nerve sheath fenestration. Peripapillary microperimetric examinations were done at presentation and after one-month of treatment. Findings were compared to values obtained from an age-matched healthy control group. RESULTS: The st...
Source: Neurological Research - September 13, 2020 Category: Neurology Tags: Neurol Res Source Type: research

Utility of Cerebrospinal Fluid and Serum Procalcitonin for the Diagnosis of Neonatal Meningitis
Conclusion CSF PCT is more specific marker for the diagnosis of neonatal meningitis as compared with serum PCT and CSF to serum PCT ratio. Key Points [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: American Journal of Perinatology)
Source: American Journal of Perinatology - September 12, 2020 Category: Perinatology & Neonatology Authors: Rajial, Tanuja Batra, Prerna Harit, Deepika Singh, Narendra Pal Tags: Original Article Source Type: research

Cerebrospinal Fluid Norepinephrine and Neurocognition in HIV and Methamphetamine Dependence
Objective: HIV disease and methamphetamine (METH) dependence share overlapping mechanisms of neurotoxicity that preferentially compromise monoamine-rich frontostriatal circuitry. However, norepinephrine (NE) function is poorly understood in HIV and METH dependence. We evaluated associations between cerebrospinal fluid (CSF) NE and HIV, METH dependence, and neurocognition. Methods: Participants included 125 adults, stratified by HIV serostatus (HIV+/HIV−) and recent METH dependence (METH+/METH−), who underwent comprehensive neurocognitive testing and lumbar puncture. CSF NE was assayed using high-performanc...
Source: JAIDS Journal of Acquired Immune Deficiency Syndromes - September 12, 2020 Category: Infectious Diseases Tags: Clinical Science Source Type: research

Frontotemporal brain sagging syndrome: Craniospinal hypovolemia secondary to a T6-T7 cerebrospinal fluid-venous fistula.
Conclusion: The FTBSS should be considered in the differential diagnosis of an early onset frontotemporal dementia. Establishing the diagnosis and localizing the site of a spinal CSF/venous leak warrant both MRI and myelogram CT studies, to pinpoint the CSF leak site for proper surgical clipping/ligation of these thoracic diverticulum/CSF-venous leaks. PMID: 32905237 [PubMed] (Source: Surgical Neurology International)
Source: Surgical Neurology International - September 11, 2020 Category: Neurosurgery Tags: Surg Neurol Int Source Type: research

Leukoencephalopathy Associated with Severe COVID-19 Infection: Sequela of Hypoxemia? [ADULT BRAIN]
SUMMARY: There is increasing evidence to suggest that complications of coronavirus disease 2019 (COVID-19) infection are not only limited to the pulmonary system but can also involve the central nervous system. Here, we report 6 critically ill patients with COVID-19 infection and neuroimaging findings of leukoencephalopathy. While these findings are nonspecific, we postulate that they may be a delayed response to the profound hypoxemia the patients experienced due to the infection. No abnormal enhancement, hemorrhage, or perfusion abnormalities were noted on MR imaging. In addition, Severe Acute Respiratory Syndrome corona...
Source: American Journal of Neuroradiology - September 8, 2020 Category: Radiology Authors: Lang, M., Buch, K., Li, M. D., Mehan, W. A., Lang, A. L., Leslie-Mazwi, T. M., Rincon, S. P. Tags: ADULT BRAIN Source Type: research

Meningoencephalitis, coronary artery and keratitis as an onset of brucellosis: a case report.
CONCLUSION: Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis. PMID: 32894070 [PubMed - as supplied by publisher] (Source: Emerging Infectious Diseases)
Source: Emerging Infectious Diseases - September 6, 2020 Category: Infectious Diseases Authors: Geng L, Feng Y, Li D, Nan N, Ma K, Tang X, Li X Tags: BMC Infect Dis Source Type: research

Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 2: Results from 108 lumbar punctures in 80 pediatric patients
New-generation, cell-based assays have demonstrated a robust association of serum autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myeli... (Source: Journal of Neuroinflammation)
Source: Journal of Neuroinflammation - September 3, 2020 Category: Neurology Authors: Sven Jarius, Christian Lechner, Eva M. Wendel, Matthias Baumann, Markus Breu, Mareike Schimmel, Michael Karenfort, Adela Della Marina, Andreas Merkenschlager, Charlotte Thiels, Astrid Blaschek, Michela Salandin, Steffen Leiz, Frank Leypoldt, Alexander Psc Tags: Research Source Type: research

Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients
New-generation cell-based assays have demonstrated a robust association of serum autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelit... (Source: Journal of Neuroinflammation)
Source: Journal of Neuroinflammation - September 3, 2020 Category: Neurology Authors: Sven Jarius, Hannah Pellkofer, Nadja Siebert, Mirjam Korporal-Kuhnke, Martin W. H ümmert, Marius Ringelstein, Paulus S. Rommer, Ilya Ayzenberg, Klemens Ruprecht, Luisa Klotz, Nasrin Asgari, Tobias Zrzavy, Romana Höftberger, Rafik Tobia, Mathias Buttmann Tags: Research Source Type: research

Parental presence during painful or invasive procedures in neonatology: A survey of healthcare professionals.
CONCLUSION: An important variability in practices concerning the role of parents during painful and invasive procedures on their child was reported. PMID: 32891481 [PubMed - as supplied by publisher] (Source: Archives de Pediatrie)
Source: Archives de Pediatrie - September 1, 2020 Category: Pediatrics Authors: Ponthier L, Ensuque P, Guigonis V, Bedu A, Bahans C, Teynie F, Medrel-Lacorre S Tags: Arch Pediatr Source Type: research

[Cerebral infarction and tuberculosis: case report and literature review].
CONCLUSION: Cerebral infarctions in patients with tuberculous meningitis are events that cannot be underestimated in terms of frequency or severity. Their poor prognosis is partly the result of insufficiently defined management, which combines anti-tuberculosis treatment and early corticosteroid therapy. PMID: 32861533 [PubMed - as supplied by publisher] (Source: Revue de Medecine Interne)
Source: Revue de Medecine Interne - September 1, 2020 Category: Internal Medicine Tags: Rev Med Interne Source Type: research

Bedside Ultrasound for the Evaluation of Epidural Hematoma After Infant Lumbar Puncture
Conclusions Epidural hematomas are frequent after LP. Perceived trauma during LP and CSF RBC counts are not adequate predictors of EH formation. Point-of-care US may be a valuable adjunct to help guide subsequent needle insertions sites for repeat attempts after an unsuccessful LP. (Source: Pediatric Emergency Care)
Source: Pediatric Emergency Care - September 1, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Preoperative evaluation using external lumbar drainage for patients with posthemorrhagic hydrocephalus: A prospective, monocentric, randomized controlled trial
Discussion: The results of this trial will demonstrate whether preoperative evaluation using temporary ELD for patients with PHH could attenuate the risk of LPS failure. Trial registration number ChiCTR2000034094; Pre-results. (Source: Medicine)
Source: Medicine - August 28, 2020 Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research

Ependymal Petechial Hemorrhages in Bacterial Meningitis
A 28-year-old male patient with a history of subacute sclerosing panencephalitis, secondary to measles infection as an infant presented to our neurology department with increasing gait difficulty and poor bladder control. An Ommaya reservoir was placed in the right frontal horn for intrathecal interferon therapy at the time of subacute sclerosing panencephalitis diagnosis 19 years ago. About a month before the current complaints, the patient experienced acute onset of seizures. This reservoir was removed at that time because of a clinical suspicion of bacterial meningitis and a lumbar puncture was positive for elevated pro...
Source: Mayo Clinic Proceedings - August 27, 2020 Category: Internal Medicine Authors: Dileep D. Monie, Fredric B. Meyer Tags: Medical image Source Type: research

A case report of glucose transporter 1 deficiency syndrome with growth hormone deficiency diagnosed before starting ketogenic diet
We report the case of a 10-year-old Caucasian boy referred for short stature (height  − 2.56 SDS) and delayed growth (growth velocity − 4.33 SDS) who was diagnosed with GHD and started treatment with recombinant human growth hormone (rhGH). Because of his history of seizures with infantile onset, deceleration of head growth with microcephaly, ataxia, and moderate intellec tual disability, a lumbar puncture was performed, which revealed a low CSF glucose concentration with a very low CSF-to-blood glucose ratio (
Source: Italian Journal of Pediatrics - August 25, 2020 Category: Pediatrics Source Type: research

Herpes simplex virus 2 vasculitis as cause of ischemic stroke in a young immunocompromised patient
We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-...
Source: Journal of NeuroVirology - August 23, 2020 Category: Neurology Source Type: research

Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain biopsies
We report on a male HIV-positive patient with PML finally diagnosed by 3 times lumbar punctures and 2 times brain biopsies. Negative results of JCV-PCR in cerebrospinal fluid (CSF) do not rule out the diagnosis of PML when clinical manifestations and neuroimaging features suspected PML. It is necessary to obtain new CSF and make repeat tests and even perform brain biopsy. (Source: Journal of NeuroVirology)
Source: Journal of NeuroVirology - August 23, 2020 Category: Neurology Source Type: research

Nusinersen treatment of spinal muscular atrophy - a systematic review.
CONCLUSIONS: Nusinersen increased survival without permanent ventilatory support in children with SMA type 1. Improvements in SMA type 2 and 3 were less evident. Better outcomes were seen in young children with a short disease duration, particularly in children receiving nusinersen before symptom onset. Newborn SMA screening may facilitate presymptomatic treatment with splice modification (nusinersen, risdiplam) or gene implantation therapy (AVXS-101, zolgensma). PMID: 32800069 [PubMed - in process] (Source: Danish Medical Journal)
Source: Danish Medical Journal - August 19, 2020 Category: General Medicine Tags: Dan Med J Source Type: research

Rethinking the need for a platelet transfusion threshold of 50  × 109 /L for lumbar puncture in cancer patients.
The objective was to compare the outcomes of LPs performed with platelets above and below this threshold. An increased risk of adverse events in patients with lower platelet counts was not expected. As a corollary, transfusion reaction rates incurred by transfusing to this recommended threshold are also reported. METHODS: A total of 2259 LPs performed on 1137 oncology patients (adult, n = 871, and pediatric, n = 266) were retrospectively analyzed between February 2011 and December 2017. The incidence of LP-related complications for groups above and below the minimum platelet threshold was compared. Traumatic tap was d...
Source: Transfusion - August 17, 2020 Category: Hematology Authors: Chung HH, Morjaria S, Frame J, Riley M, Zhang AW, Martin SC, Bhatia A, Fenelus M, Fallah F, Inumerables F, Goss C Tags: Transfusion Source Type: research

Triphasic waves in electroencephalogram as a possible early marker of carcinomatous meningitis: a case report
We report this case to demonstrate that TWs in EEG may be a prognostic marker in patients with carcinomatous meningitis. Patient concerns: A 76-year-old Chinese male displayed incremental headache, nausea, emesis, and intermittent fever for 2 months. A routine scalp EEG showed mild slow background activity. The CSF analysis demonstrated a slight increase in protein, and the white blood cell count was in the normal range. Cytology did not show any atypical cells. Viral meningitis was considered for the first time. Diagnosis: After admission, a long-term EEG was performed because of his fever and mild abnormalities in ...
Source: Medicine - August 14, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Idiopathic intracranial hypertension with stenosis of a solitary occipital venous sinus treated with stenting.
Authors: Al Balushi A, Oliveira C, Patsalides A Abstract A 47-year-old live kidney-donor woman presented with headaches and blurred vision. Neuro-ophthalmological examination demonstrated papilledema and right eye inferior nasal defect. Brain MRV showed no sinus thrombosis but solitary right venous sinus draining the torcular Herophili to right jugular bulb. Lumbar puncture revealed elevated CSF opening pressure of 40 cm H2O with normal composition. She was diagnosed with idiopathic intracranial hypertension (IIH). She did not tolerate medical management and declined CSF diversion surgery. Cerebral angiograp...
Source: Interventional Neuroradiology - August 13, 2020 Category: Radiology Tags: Interv Neuroradiol Source Type: research

Neonates With Urinary Tract Infection: Is a Lumbar Puncture Always Indicated?
Background: Our objectives were to determine the prevalence of and to identify risk factors for coexisting bacterial meningitis (BM) in neonates with urinary tract infection (UTI). Methods: A cross-sectional study was conducted at pediatric emergency department of a tertiary teaching hospital from 2001 to 2017. Infants (Source: The Pediatric Infectious Disease Journal)
Source: The Pediatric Infectious Disease Journal - August 13, 2020 Category: Infectious Diseases Tags: Maternal-Neonatal Reports Source Type: research

Ultrasound-guided lumbar puncture improves success rate and efficiency in overweight patients
Background Approximately 400,000 diagnostic lumbar punctures (LPs) are performed by neurologists yearly in the United States. There has been a transition from neurologists performing>40% of LPs 2 decades ago to now 35 kg/m2. Methods A prospective intervention study was conducted from March 2017 to March 2018 at an academic medical center. Patients were divided into ultrasound-guided LP or conventional LP. The primary outcome was the success rate of LP. The secondary outcome was the parameters regarding LP performance, the patients' feedback after procedures, and the residents' feedback about the learning modules. Resu...
Source: Neurology Clinical Practice - August 9, 2020 Category: Neurology Authors: Li, Y., Carandang, R. A., Ade, S., Flahive, J., Daniello, K. Tags: All Clinical Neurology, Models of care Research Source Type: research

High-flow oxygen and pro-serotonin agents for non-interventional treatment of post-dural-puncture headache
Post dural puncture headache (PDPH) is a common complication in patients following diagnostic or therapeutic lumbar puncture, procedures requiring epidural access, and spinal surgery. Epidural blood patch (EBP), the gold standard for the treatment of this pathology requires training not provided to emergency physicians. In addition, the presence of concomitant pathology and abnormal laboratory values are contraindications to perform EBP. In presence of these limitations, we sought for a non-interventional management of PDPH utilizing high-flow oxygen and pro-serotonin agents. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - August 2, 2020 Category: Emergency Medicine Authors: Carlos J. Roldan, Matthew Chung, Correa MC, J. Cata, Huh B Source Type: research

Posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome associated spinal subdural hematoma: A case report
We report the unique case of a 40-year-old female presented with crescendo headache, blurred vision, and recurrent generalized tonic–clonic seizure. She had a minor neck injury 1 week before but attracted no more attention. Neurological tests on admission yielded a Glasgow Coma Scale score of 13. No obvious focal neurological deficit apart from positive signs of meningeal irritation was presented. Diagnoses: Xanthochromia and hemorrhagic cerebrospinal fluid with pleocytosis was found on lumbar puncture. Cranial computed tomography was negative but magnetic resonance imaging demonstrated bilateral areas of vasogeni...
Source: Medicine - July 31, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients.
CONCLUSIONS: ALPH is an underrecognized variant phenotype of hydrocephalus that is associated with multiple etiologies and can be challenging to treat as it frequently does not initially respond to standard strategies of CSF shunting. With early recognition, ALPH can be effectively managed. A management algorithm is provided as a guide for this purpose. PMID: 32736355 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)
Source: Journal of Neurosurgery - July 30, 2020 Category: Neurosurgery Authors: Keough MB, Isaacs AM, Urbaneja G, Dronyk J, Lapointe AP, Hamilton MG Tags: J Neurosurg Source Type: research