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The aim of this work was to characterize edema dynamics, cerebral blood volume, and flow alterations in an experimental model of brain trauma using quantitative diffusion and perfusion magnetic resonance imaging
(MRI). Associated with an influx of water in the intracellular space 1-5 h post-trauma as demonstrated by the 40% reduction in apparent diffusion coefficient, a 70-80% reduction in cerebral blood flow was measured within the lesioned region.
Cephalalgia, Volume 27, Number 9, September 2007 , pp. 1033-1042(10)
Neuroimaging studies have explored cerebral activation patterns in patients with cluster headache (CH) during attacks and have revealed activation of multiple brain areas known to belong to the general pain-processing network.
To determine the strenuousness and efficacy of therapy, the energy expenditure of 10 healthy and 10 hemiparetic subjects were measured while they walked on a treadmill that was combined with a robot-driven gait
orthosis, the Lokomat, which physiologically exercises the legs of a patient on a moving treadmill. Subjects performed different Lokomat conditions after measurement of the baseline, i.e., standing in the Lokomat with 30% body weight support (BWS).
American Journal of Neuroradiology 28:1401-1402, August 2007
We report on a patient who, after a symptom-free interval, developed severe vision impairment and whose MR imaging demonstrated extensive edema in the central nervous tissue neighboring the treated aneurysm. To our knowledge, this is an unreported complication of endovascular treatment of aneurysms.
Pediatric Infectious Disease Journal. 26(9):860-862, September 2007
We describe a 16-month-old girl who suffered from encephalopathy leading to intensive care unit hospitalization, complicated by Guillain-Barre syndrome and hydrocephalus, and who had serologic and molecular evidence of central nervous system infection by B.
quintana. The possible association of B. quintana with Guillain-Barre syndrome and hydrocephalus has not been previously described and demonstrates the growing spectrum of neurologic complications of Bartonella
spp. infections.
Glutathione S-transferase omega-1 is a multifunctional enzyme. The Asp/Asp genotype of the Ala140Asp polymorphism of the GSTO1 gene has been alleged to increase the risk of vascular dementia. The objective of this study is to address the question of whether common vessel disorders known to cause vascular dementia are modified in their severity by this polymorphism.
The assessment of patients with disorders of consciousness, including the vegetative state, is difficult and depends frequently on subjective interpretations of the observed spontaneous and volitional behavior. For those patients who retain peripheral motor function, rigorous behavioral assessment supported by structural imaging and electrophysiological findings is usually sufficient to establish a patient's level of wakefulness and awareness.
Brain abscess results from local or metastatic septic spread to the brain. The primary infectious site is often undetected, more commonly so when it is distant. Unlike pediatric congenital heart disease, minor intracardiac right-to-left shunting due to patent foramen ovale has not been appreciated as a cause of brain abscess in adults.
A case of spontaneous intracranial hypotension (SIH) caused by a cerebrospinal fluid
(CSF) leak at C1-2 is described. The patient, a 46-year-old gentleman, presented to the emergency department with a severe, orthostatic neck pain and occipital headache of sudden onset. He was diagnosed with SIH and admitted, but failed to respond to conservative management. Imaging studies suggested that C1-2 was the spinal level responsible for the CSF leak, and he underwent a blood patch therapy delivered via an epidural catheter inserted from C6-7. His neck pain disappeared a day after the procedure, and he remains free of symptom for more than a year. SIH with a CSF leak at the upper cervical spine may be least amenable to conventional epidural blood patch delivered from the lumbar spine. Delivery of autologous blood patch via an epidural catheter inserted from the lower cervical spine can be a safe and effective method for such patients.
Inflammation contributes to brain damage caused by ischemic stroke. Ultrasmall superparamagnetic iron oxide
(USPIO)-enhanced MRI allows noninvasive monitoring of macrophage recruitment into ischemic brain lesions. In this study, we determined the extent of USPIO enhancement during early stages of ischemic stroke.
International Journal of Geriatric Psychiatry 11 Jul 2007
Growth in antidepressant prescribing is a well-recognised phenomenon in developed countries. In stroke care, the evidence of effectiveness from systematic reviews is surprisingly weak. We therefore decided to undertake a randomised controlled trial comparing fluoxetine to placebo.
European Journal of Neurology, Volume 14, Number 9, September 2007 , pp. 1035-1039(5)
We adopted an expanded transcranial Doppler (TCD) protocol to evaluate if additional injections of agitated saline in different positions would improve shunt detection or grading. We report the safety and feasibility of this expanded contrast TCD protocol. Patients with ischemic stroke were evaluated. The standard protocol for RLS detection was followed and expanded after the initial injection in the supine position to the right lateral
decubitus, upright sitting, and sitting with right lateral leaning.
European Journal of Neurology, Volume 14, Number 9, September 2007 , pp. 1040-1047(8)
The aim of this study was to examine the impact of Friedreich ataxia (FRDA) on quality of life
(QOL) using a generic tool to explore factors potentially associated with health status. Sixty-three individuals with genetically confirmed
FRDA, self completed the Medical Outcomes Study 36 item Short Form Health Survey Version 2 (SF-36V2) and were assessed using the FRDA Rating Scale. Disease-specific, demographic, and social characteristics were also recorded.
To determine whether or not subjects who had had a partial hand amputation were able to return to the same job and whether or not they used their silicone finger prosthesis for work.
To review literature on return to work (RTW) and employment in persons with spinal cord injury (SCI), and present employment rates, factors influencing employment, and interventions aimed at helping people with SCI to obtain and sustain productive work.
Based on a Medline search, the authors reviewed the current TBI rehabilitation literature regarding (a) predictive factors for successful
RTW, and (b) current concepts in rehabilitative strategies for successful
RTW.
Vocational rehabilitation is by definition a multidisciplinary intervention in a process linked to the facilitation of return to work or to the prevention of loss of the work. Clinical staff in contact with a person who has lost his job (general practitioner, specialized physician) must promote vocational rehabilitation. Medical rehabilitation for those with disabilities, whether new or old, has to be followed without delay by vocational rehabilitation.
To determine the relationships between perceived participation and problems in participation, and life satisfaction in people with spinal cord injury (SCI).
The purpose of this investigation is to show that listening to oral histories (OH) told by survivors of acquired brain injury
(ABI) can influence the attitudes and beliefs held by practicing Speech-Language Pathologists, and graduate and undergraduate students studying communication sciences and disorders.
Increased fracture risk is a recognized complication following stroke. Bone loss following a hemiplegic stroke has been proposed as a major risk factor for post-stroke hip fracture, with a recent focus on the development of novel therapeutic measures to prevent bone loss and fractures after stroke. We briefly review the literature on the epidemiology and pathophysiology of bone loss and hip fracture after stroke, and then critically review recent studies on preventive strategies.
To prospectively perform a decision and cost-effectiveness analysis of surgical and endovascular treatments of unruptured intracranial aneurysms, with incorporation of the results of the prospective International Study of Unruptured Intracranial Aneurysms.
Complementary Health Practice Review, Vol. 12, No. 2, 139-143 (2007)
Patients suffering from chronic diseases like epilepsy often use complementary and alternative medicine (CAM) as first-line treatment because of myths, superstitions, and stigma attached to the disease.
Subcutaneous epidermal cysts and intracranial epidermoid cysts are pathologically identical. Although diffusion-weighted imaging
(DWI) studies of intracranial epidermoid cysts have been numerously reported, those of subcutaneous epidermal cysts have not been sufficiently investigated. Our hypothesis for this study is that the apparent diffusion coefficient (ADC) values of subcutaneous epidermal cysts and intracranial epidermoid cysts are not different. This study was intended to evaluate the ADC of subcutaneous epidermal cysts of the head and neck in comparison with that of intracranial epidermoid cysts.
American Journal of Neuroradiology 28:1405-1408, August 2007
The purpose of this study was to report the midterm clinical and angiographic results of coiling of very large (>15 mm) and giant basilar tip aneurysms.
Emerging evidence suggests that the APOE4 allele may increase the risk of a negative outcome in patients with aneurysmal subarachnoid hemorrhage
(SAH), but the results are conflicting. A genetic variable predicting the individual clinical course is currently lacking.
Blood Coagulation & Fibrinolysis. 18(6):537-542, September 2007
Patent foramen ovale (PFO) is more frequent in cryptogenic stroke patients than in the general population. The aim of this study was to determine prothrombotic markers regarding PFO in young cryptogenic stroke patients.
Clinical Neurology and Neurosurgery Volume 109, Issue 8, Pages 667-671
We describe the use of a silicone elastomer sheet (SILASTIC®) to prevent peridural fibrosis in patients who underwent a craniectomy and a subsequent
cranioplasty.
Clinical Neurology and Neurosurgery Volume 109, Issue 8, Pages 698-704
Supradiaphragmatic adrenocorticotropic hormone (ACTH) secreting pituitary adenomas are exceptionally encountered (14 cases previously described) and raise issues concerning their nosology and management. If surgery is the treatment of choice, the nature of surgical approach (craniotomy, transsphenoidal approach) remains controversial. To illustrate this issue, we presented two cases of supradiaphragmatic ACTH secreting pituitary adenomas successfully excised via a subfrontal approach.
The Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial (MELT) Japan was organized to determine the safety and clinical efficacy of intraarterial infusion of urokinase (UK) in patients with stroke within 6 hours of onset.
We retrospectively analysed the outcomes of children transplanted for high-risk neuroblastoma (NB) at a single institution predominantly transplanted with total body irradiation and chemotherapy. The aims of this study were to determine the prognostic impact of clinical and biological features and to document long-term health outcomes.
Journal of Thrombosis and Haemostasis, Volume 5, Number 9, September 2007 , pp. 1862-1868(7)
Endogenous resistance to tissue-type plasminogen activator (t-PA) might decrease the benefit of
thrombolysis-induced recanalization. Thrombin-activatable fibrinolysis inhibitor
(TAFI) and plasminogen activator inhibitor-1 (PAI-1) are fibrinolysis inhibitors. TAFI removes residues from partially degraded fibrin that in turn eliminates plasminogen binding sites; PAI-1 directly inhibits the activity of t-PA. We aimed to study whether the presence of two common functional polymorphisms of the TAFI and PAI-1 genes influence rates of recanalization of the middle cerebral artery (MCA) among t-PA-treated stroke patients.
American Journal of Neuroradiology 28:1299-1303, August 2007
Our aim was to evaluate whether increasing iodine concentration, at a constant total iodine dose, resulted in better brain tissue opacification in patients with acute stroke symptoms during their evaluation by first-pass CT perfusion (CTP).
American Journal of Neuroradiology 28:1280-1286, August 2007
The purpose of this work was to demonstrate susceptibility effects (SusE) in various types of brain tumors with 3T high-resolution (HR)-contrast-enhanced (CE)-susceptibility-weighted
(SW)-MR imaging and to correlate SusE with positron-emission tomography (PET) and histopathology.
We report 10 cases of status epilepticus (SE) in patients with posterior reversible encephalopathy syndrome (PRES). In all cases, SE brought PRES to medical attention. The majority of the cases had focal-onset complex partial SE. Complete resolution of SE was achieved after combined treatment of PRES and SE in all cases. SE in the setting of PRES carries a favorable prognosis but requires timely recognition and treatment of the course of PRES.
Pretreatment with statins has been shown to reduce brain injury in cerebral ischemia. In this controlled randomized study, we investigated the influence of statin pretreatment and its withdrawal on the outcome of acute ischemic stroke patients.
IV thrombolysis represents the most effective acute stroke therapy. However, it is almost exclusively performed in stroke centers and is not available in most community areas. The Telemedical Pilot Project for Integrative Stroke Care
(TEMPiS) was started in February 2003.
A rat model of spinal cord injury was used to test the hypothesis that Nogo-A monoclonal antibody (NEP1-40) promotes morphologic and functional recoveries of injured spinal cord.
Attention deficit-hyperactivity disorder (ADHD) is a socially disabling condition whose pathophysiology is mostly unknown. Previous magnetic resonance imaging
(MRI)-based reports have shown structural abnormalities in the prefrontal region and the striatum, but with inconsistencies across the studies with regard to right/left specificity of changes. Our study is aimed at finding evidence of dysfunction with more refined MRI techniques such as diffusion-weighted MRI and spectroscopy.
Rationale and Objectives
To determine the sensitivity of susceptibility-weighted imaging (SWI) for depicting hemorrhagic hypointense foci of the brain in comparison with gradient-recalled echo (GRE)- and GRE-type single-shot echo-planar imaging
(GREI, GRE-EPI), and to assess the basic characteristics of the susceptibility effect by using a phantom.
Health Care Management Science, Volume 10, Number 3, September 2007 , pp. 253-267(15)
For the Department of Veterans Affairs (VA), traumatic brain injury (TBI) is a significant problem facing active duty military personnel, veterans, their families, and caregivers. The VA has designated TBI treatment as one of its physical medicine and rehabilitation special emphasis programs, thereby providing a comprehensive array of treatment services to those military personnel and veterans with
TBI.
Clinical Physiology and Functional Imaging, Volume 27, Number 5, September 2007 , pp. 263-267(5)
The present study was designed to assess how anaerobic exercise affects auditory brainstem response
(ABR) parameters, and whether one night of sleep deprivation could alter these possible exercise-induced changes in
ABRs.
There is no effective medical treatment of malignant middle cerebral artery (MCA) infarction. The purpose of this clinical trial was to assess the efficacy of early decompressive craniectomy in patients with malignant MCA infarction.
Because the mechanism for scavenging acidophilic electron-dense dead neurons disseminated among the neuritic networks of surviving neurons in the ischemic penumbra of the cerebral cortex is still obscure, we investigated the fate of them up to 24 weeks after the ischemic insult.
Systematic reviews have shown that organized inpatient (stroke unit) care reduces the risk of death after stroke. However, it is unclear how this is achieved. We tested whether stroke unit care could reduce deaths by preventing complications.
Intrapleural fibrinolytic therapy is a technique used to treat empyemas and parapneumonic effusions. Cerebral air embolism is an unusual potentially severe complication of this technique.
European Journal of Neurology, Volume 14, Number 9, September 2007 , pp. 989-992(4)
Chronic obstructive pulmonary disease (COPD) is a risk factor for cardiovascular disorders and different types of stroke. The present retrospective study investigates whether COPD is also a risk factor for the development of seizures in stroke patients.
High intracranial pressure (HICP) may be a very early event after traumatic brain injury
(TBI), but in most cases, especially when contusions and edema develop over time, HICP will worsen over succeeding days. This study describes the incidence and severity of elevated intracranial pressure
(ICP) after TBI and attempts to document its time course. In this prospective study, 201 TBI patients in whom ICP was monitored for more than 12 h were evaluated.
Serum magnesium concentration has a neuroprotective effect in experimental models of traumatic brain injury
(TBI). This study was designed to assess the relationship between initial serum magnesium, cerebrospinal fluid
(CSF) magnesium, neurological outcome and the efficacy of magnesium replacement therapy (MgSO4). A retrospective analysis was performed on a prospectively collected dataset from 216 patients admitted during 1996-2006 to the University of Pittsburgh Medical Center with severe
TBI.
A comparison of outcomes between different modes of head-injury treatment in the elderly has important bearing on questions of cost-effectiveness and medical ethics. Here, we have examined rates of mortality in elderly head-trauma victims to determine whether it is valid to differentiate an "edge" age group of younger elderly patients, 65-74 years of age, from older elderly patients, considering possible benefit from intensive treatment and surgical intervention.
The ABCD scoring system has been described as a simple way of predicting stroke in the first 7 days after a transient ischaemic attack (TIA). The aims of our pilot study were to find out if emergency department (ED) doctors could use the scoring system effectively and if this system would influence admission rates and patient selection.
Biochemical markers of cellular stress/injury have been proposed to indicate outcome after head injury. The aim of the present study was to determine whether plasma von Willebrand factor
(VWF) levels correlate with primary outcome and with clinical variables in severe traumatic brain injury
(TBI).
Few patients with acute stroke are treated with alteplase, often due to significant prehospital delays after symptom onset. The aims of this study were to: (1) identify factors associated with rapid first medical assessment in the emergency department after a call for ambulance assistance, and (2) determine the impact of ambulance practice on times from the ambulance call to first medical assessment in the emergency department.
Mild hypothermia confers profound neuroprotection in ischemia. We recently discovered 2 natural derivatives of
thyroxine, 3-iodothyronamine (T1AM) and thyronamine (T0AM), that when administered to rodents lower body temperature for several hours without induction of a compensatory homeostatic response. We tested whether T1AM- and T0AM-induced hypothermia protects against brain injury from experimental stroke.
Angiogenesis is thought to depend on a perfectly coordinated balance between endogenous-positive and negative regulatory factors. Of these factors, the vascular endothelial growth factor
(VEGF) and angiopoietins (Angs) seem to play an essential role.
Decompressive surgery (hemicraniectomy) for life-threatening massive cerebral infarction represents a controversial issue in neurocritical care medicine. We report here the 30-day mortality and 6- and 12-month functional outcomes from the DESTINY trial.
American Journal of Neuroradiology 28:1320-1327, August 2007
Although the term posterior reversible encephalopathy syndrome (PRES) was popularized because of the typical presence of vasogenic edema in the parietal and occipital lobes, other regions of the brain are also frequently affected. We evaluated lesion distribution with CT and MR in a large cohort of patients who experienced PRES to comprehensively assess the imaging patterns identified.
Journal of Intensive Care Medicine, Vol. 22, No. 4, 194-207 (2007)
There has been controversy regarding the risk of cerebral herniation caused by a lumbar puncture (LP) in acute bacterial meningitis (ABM). This review discusses in detail the issues involved in this controversy. Cerebral herniation occurs in about 5% of patients with ABM, accounting for about 30% of the mortality.
American Journal of Neuroradiology 28:1287-1291, August 2007
Little is known about the metabolic properties of brain edema associated with tumors. This work was conducted on the basis of the assumption that, in the presence of intra-axial and extra-axial brain tumors, the white matter involved by the edema is a site of metabolic change that involves the structure of the myelin sheath.
European Journal of Nuclear Medicine and Molecular Imaging, Volume 34, Number 7, July 2007 , pp. 1061-1070(10)
Eleven healthy volunteers were studied twice. Eight brain regions ranging from high to low receptor binding were examined. [18F]CPFPX was injected as a bolus with subsequent infusion over 120 min. Various outcome parameters were compared based on either metabolite-corrected venous blood sampling [e.g. apparent equilibrium total distribution volume
(DVt')] or a reference region [ratio of specific to non-specific distribution volume (BP2)].
Modern Rheumatology, Volume 17, Number 3, June 2007 , pp. 251-252(2)
We report a 34-year-old woman who developed primary antiphospholipid antibody syndrome
(APS) presenting with dysfunctional uterine bleeding and cerebral infarction. Antiphospholipid antibody syndrome presenting with bleeding manifestations is rare. We should recognize that APS may be associated with not only thrombosis but also bleeding.
American Journal of Neuroradiology 28:1292-1298, August 2007
Hemorrhagic transformation (HT) can be a devastating complication of acute ischemic stroke
(AIS). The purpose of this study was to determine whether increased microvascular permeability (PS) of the blood-brain barrier was detected in early AIS by using first-pass dynamic perfusion CT (PCT) and whether PS was significantly higher in infarcts destined for HT.
American Journal of Neuroradiology 28:1395-1400, August 2007
Five to 60% of coiled brain aneurysms recanalize, generally because of coil compaction. In vitro exclusive use of complex-shaped coils allows better packing of the aneurysmal sac and the neck as compared with helical coils. We report a single-center, prospective study using complex coils. Safety, packing density, and recanalization rate were evaluated.
The diagnosis of nonconvulsive status epilepticus (NCSE) is particularly challenging in elderly patients. Confusion, personality change, dysphasia, subtle motor activity and nystagmus may be the only presenting signs.
American Journal of Neuroradiology 28:1223-1231, August 2007
Brain imaging is an integral part of the diagnostic work-up for metabolic disorders, and the bedside availability of cranial ultrasonography
(cUS) allows very early brain imaging in symptomatic neonates. Our aim was to investigate the role and range of abnormalities seen on cUS in neonates presenting with metabolic disorders. A secondary aim, when possible, was to address the question of whether brain MR imaging is more informative by comparing cUS to MR imaging findings.
To examine the effects of an awareness training protocol embedded within the practice of instrumental activities of daily living
(IADLs) in participants with acquired brain injury on levels of self-awareness and functional performance.
To examine whether the caregivers' coping style is associated with the functional outcome of the traumatic brain injury
(TBI) patient 1 year post-injury.
To investigate the relation between psychosocial functioning (community integration, life satisfaction and social support) and symptoms (post-concussion, post-traumatic stress and depression) in persons with mild traumatic brain injury
(MTBI) 3 years after the trauma.
The aim of the current study was to examine whether neural reserve influenced the duration of post-traumatic amnesia (PTA) following mild traumatic brain injury
(MTBI).
To the authors' knowledge no study comparing very long-term neuropsychological outcome after mild paediatric and adult traumatic brain injury
(TBI) has been published. The primary objective of this study was to compare neuropsychological outcome 23 years after mainly mild paediatric and adult
TBI.
Clinical management of acute traumatic brain injury (TBI) has emphasized identification of secondary mechanisms of
pathophysiology. An important objective in this study is to use proton magnetic resonance spectroscopy
(pMRS) to examine early metabolic disturbance due to TBI.
This case report shows how recurrent bone fractures can increase the tension in the relationship between family and caregivers in the long-term care of a patient in a vegetative state (VS). The aim of this report is to prevent conflict situations elsewhere by informing the family in time about the risk of fractures in a situation of severe osteoporosis.
A 20-year-old hunter was shot accidentally during hunting. At autopsy, the body showed no significant injuries or deformity except for the pellet injuries and ecchymosis on the medial side of the left lower eyelid. Skull roentgenography located a pellet in the base of the cranium. Upon craniotomy, the cause of death was diagnosed as subarachnoidal haemorrhage due to incomplete basilar artery injury. The pellet entered through the medial cantus, passed through the inferior orbital fissure than the sphenooccipital junction and basilar artery and lodged in the
pons.
We are developing a software system called IDA (Input Device Agent), whose goal is to optimally configure input devices for people with physical impairments. This study assessed IDA's ability to recommend three keyboard parameters in response to measurements of typing performance: repeat rate, repeat delay, and use of
StickyKeys.
Provision of a wheelchair has immediate intuitive benefits; however, it can be difficult to evaluate which wheelchair and seating components best meet an individual's needs. As well, funding agencies now prefer evidence of outcomes; and therefore measurement upon prescription of a wheelchair or its components is essential to demonstrate the efficacy of intervention. As no existing tool can provide individualized goal-oriented measure of outcome after wheelchair prescription, a research project was undertaken to create the Wheelchair Outcome Measure
(WhOM)
A learning setup was arranged for an adolescent with profound multiple disabilities and a diagnosis of vegetative state. Signs of learning by the adolescent would underline an improvement in his immediate situation with potential implications for his general prospect, and could help revise his diagnosis.
The association between abdominal obesity and atherosclerosis is believed to be due to excess visceral adipose tissue (VAT), which is associated with traditional risk factors. We hypothesized that VAT is an independent risk factor for atherosclerosis.
The initial steps of atherosclerosis and the entry of HIV into the cell share similar biological mechanisms. Therefore, our hypothesis is that the progression of atherosclerosis in patients with HIV infection can be influenced by variations in genes implicated in both processes.
Indian Journal of Orthopaedics 2007 Volume 4 Issue : 3 194-197
The western literature on deep vein thrombosis (DVT) and pulmonary embolism (PE) following spinal cord injury (SCI) report an alarmingly high incidence, necessitating
thromboprophylaxis. The literature on incidence from the Asian subcontinent is scanty and from India is almost nonexistent.
Journal of Neuro-Oncology, Volume 83, Number 3, July 2007 , pp. 259-266(8)
Vascular endothelial growth factor (VEGF) is considered to be a major regulator of angiogenesis in various brain tumors. In this study, we determined the expression levels of
VEGF, and vascular endothelial growth factor receptor (VEGFR)-1 and -2 mRNA in 46 intracranial schwannomas by quantitative real-time
PCR, and correlated these with various clinical factors or other molecular markers.
Neural regeneration and repair in the central nervous system are currently hot topics in neuroscience. For many years there has been a hope that neurodegenerative diseases which are resistant to current therapies may be treated by the selective replacement of cells. Yet it is only recently that we have started to acquire the knowledge, tools, and techniques that may translate such optimism into new therapies. In this article, we will consider the potential to restore function to the damaged optic nerve. We will consider the technical issues involved and suggest a strategy for research progress.
Journal of Trauma-Injury Infection & Critical Care. 63(2):439-442, August 2007
Oxidative stress has been indicated as a mechanism of secondary neuronal injury in traumatic brain injury
(TBI). Nitrotyrosine in the cerebrospinal fluid (CSF) may be an in vivo marker of oxidative nitric oxide damage. We tested the hypothesis that increased levels of nitrotyrosine correlate with poor neurologic outcomes in patients with TBI and attempted to identify the source of increased CSF
nitrotyrosine.
Pediatric Hematology and Oncology, Volume 24, Issue 6 July 2007 , pages 409 - 415
Despite progress in the treatment of pediatric cancer, approximately 25% of these children will die of the disease. The last period of life is characterized by profound physical and psychological suffering, both of the children and their loved ones. Adequate alleviation of this suffering becomes the priority in the management of these patients.
European Radiology, Volume 17, Number 7, July 2007 , pp. 1663-1668(6)
In temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS), ictal discharge spread to the frontal and insulo-perisylvian cortex is commonly observed. The implication of white matter pathways in this propagation has not been investigated. We compared diffusion tensor imaging (DTI) measurements along the uncinate fasciculus
(UF), a major tract connecting the frontal and temporal lobes, in patients and controls.
European Radiology, Volume 17, Number 7, July 2007 , pp. 1675-1684(10)
Although multimodality therapy for high-grade gliomas is making some improvement in outcome, most patients will still die from their disease within a short time. We need tools that allow treatments to be tailored to an individual.
American Journal of Neuroradiology 28:1354-1361, August 2007
Our goal was to improve the preoperative assessment of the corticospinal tract (CST) in patients with brain tumors. We investigated whether the integration of functional MR imaging
(fMRI) data and diffusion tensor (DT) tractography can be used to evaluate the spatial relationship between the hand and foot fibers of the CST and tumor borders.
To characterize short-term prognoses among patients with transient ischemic attack (TIA) and normal diffusion-weighted imaging
(DWI) results, TIA patients with abnormal DWI results (transient symptoms associated with infarction
[TSI]), and patients with completed ischemic stroke (IS).
Current Opinion in Pulmonary Medicine. 13(5):372-376, September 2007
There is increasing information on the natural history of cerebral vein thrombosis. The objectives of this review are to evaluate the mortality rates and the rate of residual disability in cerebral vein thrombosis patients, to determine clinical and radiological predictors of death and dependence, and to estimate the cumulative incidence of recurrent cerebral vein thrombosis after a first episode.
17 cases reviewed prospectively over a period of 4 months highlight the varied appearance of blood-fluid levels in intracranial cystic lesions of different
aetiologies; a finding which has not featured significantly in the medical literature. Four types of intracranial cysts demonstrating blood-fluid levels have been categorised according to the nature of the pathology, i.e. primary neoplasms of the brain, metastatic deposits to the brain in cases of extraneural malignancies, lesions of vascular aetiology and intraparenchymal bleeds secondary to trauma.
Journal of Neuro-Oncology, Volume 83, Number 3, July 2007 , pp. 223-231(9)
The basic mechanism of cell death induced by 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT) (ALA-PDT) in glioma cells has not been fully elucidated. In this study, the details of the cell death mechanism induced by ALA-PDT were investigated in three human glioma cell lines (U251MG, U87MG, and U118MG) in vitro.
Journal of Neuro-Oncology, Volume 83, Number 3, July 2007 , pp. 325-328(4)
Patients with B-cell chronic lymphocytic leukemia (CLL) have an increased risk of second malignancy and may develop diffuse large-cell non-Hodgkin's lymphoma
(DLCL) also known as Richter's syndrome (RS).
Pediatric & Child's Health July/ August 2007, Volume 12, Number 6:482-484
It is clear that paediatric minor head injuries are common and that most cases may be observed without
neuroimaging. However, with easier access to computed tomography scans, there has been an increase in its use.
Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage
(SAH). Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent delayed ischemic neurological deficits (DID) in one-third of patients. The pathophysiology of this reversible vasculopathy is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells.
Emerging evidence suggests that the APOE4 allele may increase the risk of a negative outcome in patients with aneurysmal subarachnoid hemorrhage
(SAH), but the results are conflicting. A genetic variable predicting the individual clinical course is currently lacking.
To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography
(TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmal subarachnoid hemorrhage
(SAH).
To describe the difficulty in diagnosing spinal pseudomeningocoele. A case of progressive sacral swelling in a paraplegic man who sustained spinal cord injury 14 years ago is presented.
Journal of Head Trauma Rehabilitation. International Programs and Perspectives on Traumatic Brain Injury Rehabilitation. 22(4):221-228, July/August 2007
This study describes the establishment of a Danish national strategy for treatment and rehabilitation of acquired brain injury, particularly traumatic brain injury, in 1997. The vision was to create a system of tax-financed continuous treatment, restoration of function, and outpatient rehabilitation. Recommendations and their fulfillment are described.
Current Medical Research and Opinion, Volume 23, Number 7, July 2007 , pp. 1627-1636(10)
Providing a quantitative prognosis after a stroke is important to clinicians and patients as well as to researchers interested in projecting the results of clinical trials and other studies. Thus, we critically reviewed the evidence supporting the prognostic value of two frequently-used measures, the Barthel Index (BI) and modified Rankin Scale
(mRS) for long-term outcomes.
European Radiology, Volume 17, Number 7, July 2007 , pp. 1669-1674(6)
The purpose of the study was to examine the brain and the visual pathway of patients with
non-arteritic anterior ischaemic optic neuropathy (NAION) by using conventional MRI
(cMRI) and volumetric magnetisation transfer imaging (MTI).
The use of intravenous thrombolysis is restricted to a minority of patients by the rigid 3-hour time window. This window may be extended by using modern imaging-based selection algorithms. We assessed safety and efficacy of
MRI-based thrombolysis within and beyond 3 hours compared with standard CT-based
thrombolysis.
The clinical presentation of stroke usually includes sensory' motor impairment, cranial nerve palsies, or cognitive dysfunction. Disorders in behaviour are less frequently seen. The case of a patient with a very disturbing presentation, which included a disturbance in vigilance, bilateral third nerve palsy and masturbating
behaviour, is presented. The topography of the lesions and its implications on the deficits observed are discussed.
Knowledge of the genetic architecture of ischemic stroke has been quite limited. Most significant associations of candidate genes with ischemic stroke have been difficult to replicate. This might be because the associations were not strong enough for results to be consistent, and testing a mixture of heterogeneous ischemic strokes might lead to confounded genetic associations.
Journal of Neuro-Oncology, Volume 83, Number 3, July 2007 , pp. 241-247(7)
The transplantation of progenitor cells is a promising new approach for the treatment of
gliomas. Marrow stromal cells (MSC) are possible candidates for such a cell-based therapy, since they are readily and autologously available and show an extensive tropism to gliomas in vitro and in vivo.
Journal of Neuro-Oncology, Volume 83, Number 3, July 2007 , pp. 249-258(10)
Cell division is an elemental process, and mainly consists of chromosome segregation and subsequent
cytokinesis. Some errors in this process have the possibility of leading to carcinogenesis. Aurora-B is known as a chromosomal passenger protein that regulates cell division. In our previous studies of giant cell
glioblastoma, we reported that multinucleated giant cells resulted from aberrations in cytokinesis with intact nuclear division occurring in the early mitotic phase, probably due to Aurora-B dysfunction.
Pyridoxine-dependent seizures (PDS) is a rare, autosomal recessively inherited disorder. Recently
-aminoadipic semialdehyde (-AASA) dehydrogenase deficiency was identified as a major cause of
PDS, which causes accumulation of both -AASA and pipecolic acid (PA) in body fluids.
American Journal of Neuroradiology 28:1415-1417, August 2007
This report describes a series of patients for whom dural arteriovenous fistulae
(DAVFs) of the cavernous sinus were successfully embolized using a
percutaneous, transorbital technique to directly cannulate the cavernous sinus. A vascular access needle and catheter are percutaneously advanced along the inferolateral aspect of the orbit to access the cavernous sinus via the superior orbital fissure. Safe and effective embolization is achieved without the need for a surgical cut-down.
Journal of Trauma-Injury Infection & Critical Care. 63(2):370-372, August 2007
Management of a patient with a closed head injury is based on neurologic status and computerized tomography scan results. We hypothesized that those patients with an epidural hematoma
(EDH) or subdural hematoma (SDH) <1 cm in thickness could safely be treated
nonoperatively.
Leukoaraiosis is used interchangeably with the term white matter lesions on MRI and seen to some degree in more than half of the routine scans in older persons. Clinicians often struggle to explain the implications of these findings to their patients. Recent data on the progression rate of ischemic white matter damage and its cognitive consequences may help in patient counseling and have implications on treatment trials in vascular cognitive impairment.
Cerebral blood flow is coupled to brain metabolism by means of active modulation of cerebrovascular resistance. This homeostatic vasogenic activity is reflected in slow waves of cerebral blood flow velocities (FV) which can also be detected in intracranial pressure
(ICP). However, effects of increased ICP on the modulation of cerebral blood flow are still poorly understood. This study focused on the question whether ICP has an independent impact on slow waves of FV within the normal cerebral perfusion pressures range.
Journal of Neurology, Neurosurgery, and Psychiatry 2007;78:959-963
Stroke is a leading cause of death and disability in developing countries, afflicting individuals at a young age. The contribution of established vascular risk factors to ischaemic stroke in young adults has not been evaluated systematically in Indians.
Journal of Neurology, Neurosurgery, and Psychiatry 2007;78:954-958
In patients with posterior inferior cerebellar artery infarction (PICAI) or lateral medullary infarction
(LMI), the ipsilateral vertebral artery is often hypoplastic and therefore at an increased risk of ischaemic stroke.
Valid epidemiological data on incidence and outcome of traumatic brain injury
(TBI) show great variability. A study on incidence, severity and outcome of TBI was conducted in an urban area of one million inhabitants.
Journal of Neuro-Oncology, Volume 83, Number 3, July 2007 , pp. 279-284(6)
We reviewed the notes, diagnostic imaging and treatment charts of 30 consecutive paediatric patients (age less than 18 years at diagnosis, range 0.5-17 years) presenting with a malignant glioma presenting to the paediatric oncology unit at the Royal Marsden Hospital over a 10-year period. The imaging at the time of first relapse was compared with the initial diagnostic scans to define a relapse as local, marginal or distant.
We have previously shown that a single 75-mg tablet of clopidogrel, taken before carotid
endarterectomy, significantly reduces postoperative embolization, a marker of thromboembolic stroke. This study explores the antiplatelet effect of this submaximal dose.
Subcortical hyperintensities (SH) have not been systematically evaluated in mild cognitive impairment (MCI). We sought to describe their frequency and distribution, and to test their association with cognitive characteristics in MCI patients.
Inferior olivary hypertrophy (IOH) may develop after pontine hemorrhage and may become a pacemaker for symptomatic palatal tremor
(SPT). However, there is no information available that elucidates how IOH may affect the functional outcome. The purpose of this study was to investigate how frequently IOH was associated with clinical manifestations of involuntary movements, including ocular myoclonus (OM) and
SPT, and whether IOH influenced the functional outcome after pontine hemorrhage.
Clinical 3-tesla magnetic resonance imaging systems are becoming widespread. No studies have examined differences between 1.5-tesla and 3-tesla imaging for the assessment of hyperacute ischemic stroke (<6 h from symptom onset). Our objective was to compare 1.5-tesla and 3-tesla diffusion and perfusion imaging for hyperacute stroke using optimized protocols.
Race/ethnicity is associated with overall incidence of intracranial hemorrhage (ICH), but its impact in patients with brain arteriovenous malformation is unknown. We evaluated whether race/ethnicity was a risk factor for ICH in the natural course in a large, multiethnic cohort of patients with brain arteriovenous malformation followed longitudinally.
Journal of Head Trauma Rehabilitation. International Programs and Perspectives on Traumatic Brain Injury Rehabilitation. 22(4):229-233, July/August 2007
In Sweden, traumatic brain injury (TBI) is a major cause of disability across all ages, and the need for rehabilitation and long-term follow-up is as important as in many other countries. This article presents the rehabilitation of TBI in Sweden. Strengths and weaknesses of TBI rehabilitation within the Swedish healthcare system are described, together with examples of research and development.
The study purpose was to identify patterns of variation in stroke incidence among days of the week and examine if it is modified by conventional stroke risk factors: hypertension, diabetes, drinking and smoking.
Human brain arteriovenous malformation tissue displays increased levels of vascular endothelial growth factor
(VEGF) as well as matrix metalloproteinase (MMP)-9, a tissue protease associated with various intracerebral hemorrhage
(ICH). We hypothesized that increased MMP-9 was associated with ICH induced by vascular endothelial growth factor hyperstimulation and that this effect could be attenuated by nonspecific MMP inhibition.
Whole-brain radiotherapy (WBRT) to 30 grays (Gy) in 10 fractions is the standard treatment in patients with multiple brain metastases in the majority of treatment centers worldwide. The current study investigated the potential benefit of dose escalation beyond 30
Gy.
The current study was conducted to compare 2 treatment regimens including surgical resection and whole-brain radiotherapy
(WBRT) for patients with 1 to 2 brain metastases.
Transplant Infectious Disease, Volume 9, Number 3, September 2007 , pp. 211-213(3)
Amebic encephalitis is an uncommon central nervous system infection, usually caused by Acanthamoeba
spp., which generally occurs in immunocompromised individuals. The infection might start from a minor, slowly progressive, skin ulceration that can be present for weeks to months before neurologic changes occur. We present a 40-year-old male with multiple visceral
allografts, on immunosuppression, 9 months after transplantation.
American Journal of Neuroradiology 28:1332-1338, August 2007
It is difficult to differentiate the cause of brain abscesses with the use of CT and MR imaging. We did a comparative evaluation of
pyogenic, tubercular, and fungal brain abscesses by using conventional, diffusion-weighted imaging
(DWI), and proton MR spectroscopy (PMRS) with an aim to define the unique features that may differentiate among the
pyogenic, tubercular, and fungal brain abscesses.
Intracerebral hemorrhage constitutes an often fatal sequela of thrombolytic therapy in patients with ischemic stroke. Early
blood' brain barrier disruption may play an important role, and the astroglial protein S100B is known to indicate
blood' brain barrier dysfunction. We investigated whether elevated pretreatment serum S100B levels predict hemorrhagic transformation (HT) in thrombolyzed patients with stroke.
Ictal asystole (IA) is a rare event mostly seen in patients with temporal lobe epilepsy
(TLE) and a potential contributor to sudden unexplained death in epilepsy
(SUDEP). Clinical and video-electroencephalographic findings associated with IA have not been described, and may be helpful in screening for high risk patients.
Journal of the International Neuropsychological Society (2007), 13: 770-780 Cambridge University Press
The aim of the present study was to assess the functioning of the different subsystems of working memory after severe traumatic brain injury
(TBI). A total of 30 patients with severe chronic TBI and 28 controls received a comprehensive assessment of working memory addressing the phonological loop (forward and backward digit span; word length and phonological similarity effects), the visuospatial sketchpad (forward and backward visual spans), and the central executive (tasks requiring simultaneous storage and processing of information, dual-task processing, working memory updating).
Journal of the International Neuropsychological Society (2007), 13: 846-853 Cambridge University Press
Intense language training has been found to be more efficient in the rehabilitation of chronic aphasia than treatment spread across time. Intense treatment, however, challenges personnel and financial resources of the health care system. The present study examined, whether laypersons can be trained to apply standardized language training for chronic aphasia with effects comparable to training by experts. Twenty individuals with chronic aphasia participated in the training, Constraint-Induced Aphasia Therapy
(CIAT), which comprises communicative language games with increasing level of difficulty in a motivating context for 3 hr/day on 10 consecutive days.
Journal of the International Neuropsychological Society (2007), 13: 898-902 Cambridge University Press
The present study explores the construct and ecological validity of the Biber Cognitive Estimation Test
(BCET) in a traumatic brain injury (TBI) sample. Participants completed the BCET in the course of a neuropsychological evaluation at 1–15 years after injury. BCET scores correlated moderately with other standard measures of executive functioning, and contrary to our hypotheses, at least as high with neuropsychological tests with minimal demands on executive functioning. Moreover, partialing out the portion of BCET variance not attributable to executive functioning markedly attenuated the former correlations.
Journal of the International Neuropsychological Society (2007), 13: 747-757 Cambridge University Press
Impaired ability to conduct daily activities is a diagnostic criterion for dementia and a determinant of healthcare services utilization and caregiver burden. What predicts decline in instrumental activities of daily living
(IADLs) is not well understood. This study examined measures of episodic memory, executive function, and MRI brain volumes in relation to baseline IADLs and as predictors of rate of IADL change. Participants were 124 elderly persons with cognitive function between normal and moderate dementia both with and without significant small vessel cerebrovascular disease. Random effects modeling showed that baseline memory and executive function (EXEC) were associated with baseline IADL scores, but only EXEC was independently associated with rate of change in
IADLs. Whereas hippocampal and cortical gray matter volumes were significantly associated with baseline IADL scores, only hippocampal volume was associated with IADL change.
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