| 02/02/2006
09:42 AM
Prognostic Significance for Stroke of a Morning Pressor Surge and a Nocturnal Blood Pressure Decline
Hypertension. 2006;47:149.
There is continuing controversy over whether the pattern of circadian blood pressure (BP) variation that includes a nocturnal decline in BP and a morning pressor surge has prognostic significance for stroke risk. In this study, we followed the incidence of stroke in 1430 subjects aged 40 years in Ohasama, Japan, for an average of 10.4 years. The association between stroke risk and the pattern of circadian BP variation was analyzed with a Cox proportional hazards model after adjustment for possible confounding factors. There was no significant association between total stroke risk and the nocturnal decline in BP (percentage decline from diurnal level) or between total stroke risk and the morning pressor surge. The cerebral infarction risk was significantly higher in subjects with a <10% nocturnal decline in BP as compared with subjects who had a 10% nocturnal decline in BP (P=0.04). The morning pressor surge was not associated with a risk of cerebral infarction. On the other hand, an increased risk of cerebral hemorrhage was observed in subjects with a large morning pressor surge (25 mm Hg; P=0.04). Intracerebral hemorrhage was also observed more frequently in extreme dippers (those with a 20% nocturnal decline in BP) than dippers (those with a 10% to 19% decline; P=0.02). A disturbed nocturnal decline in BP is associated with cerebral infarction, whereas a large morning pressor surge and a large nocturnal decline in BP, which are analogous to a large diurnal increase in BP, are both associated with cerebral hemorrhage.
02/01/2006
01:51 PM
NICE guideline for the management of head injury an audit demonstrating its impact on a district general hospital with a cost analysis for England and Wales
Emergency Medicine Journal 2006;23:109-113
To answer concerns related to implementation of the National Institute for Clinical Excellence (NICE) guideline on the management of head injury by determining the impact on the workload of a district general hospital. Increased computed tomography (CT) was of particular concern (cost, radiation risk, and delivery constraints).
02/01/2006
01:49 PM
Prefrontal Set Activity Predicts Rule-Specific Neural Processing during Subsequent Cognitive Performance
The Journal of Neuroscience, January 25, 2006, 26(4):1211-1218
Prefrontal neurons have been shown to represent task rules. Here we show the mechanisms by which the rule-selective activity in the prefrontal cortex influences subsequent cognitive performance based on that rule. Using functional magnetic resonance imaging, we found that the frontopolar cortex interacted with posterior areas differently depending on whether subjects were going to perform a phonological or semantic task. Moreover, we found that the sustained "set" activity in this region predicted the activity that could be recorded in the posterior areas during the performance, as well as the speed of that performance. We argue that the prefrontal set activity does not reflect simple maintenance of the task rules but the process of implementing the rule for subsequent cognitive performance and that this is done through rule-selective interactions with areas involved in execution of the tasks.
02/01/2006
01:48 PM
Standards for head injury management in acute hospitals: evidence from the six million population of the Eastern region
Emergency Medicine Journal 2006;23:128-132; doi:10.1136/emj.2005.024737
To develop standards of care for head injury and thereby identify and prioritise areas of the service needing development; to report the findings from a survey of compliance with such standards in the Eastern region of UK
02/01/2006
01:47 PM
Increased Propensity to Seizures After Chronic Cortical Deafferentation In Vivo
Neurophysiol 95: 902-913, 2006. First published October 19, 2005
Cortical injury may lead to clinical seizures. We investigated the changing patterns of the sleeplike slow oscillation and its tendency to develop into paroxysmal activity consisting of spike-wave (SW) complexes at 2–4 Hz after partial deafferentation of the suprasylvian
gyrus. Experiments were carried out in anesthetized cats, at different time intervals (wk 1 to wk 5, W1–W5) after cortical undercut. Multisite field potentials and single or dual intracellular recordings from the whole extent of the deafferented gyrus were used. The field components of the slow oscillation increased in amplitudes and were transformed into paroxysmal patterns, expressed by increased firing rates and tendency to neuronal bursting. The incidence of SW seizures was higher with transition from semiacute (W1) to chronic (W2–W5) stages after cortical undercut. The propagation delay of low-frequency activities decreased from W1 to W5, during both the slow oscillation and seizures. The initiation of seizures took place in territories contiguous to the relatively intact cortex (area 5 in the anterior part of the
gyrus), as shown by cross-correlations of field potentials from different sites and simultaneous intracellular recordings from the anterior and posterior parts of the
gyrus. The increased amplitudes of both slow oscillation and SW seizures, and their enhanced synchrony expressed by shorter time of propagation, are ascribed to increased neuronal and network excitability after cortical undercut.
02/01/2006
01:46 PM
The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage
Clinical Endocrinology doi:10.1111/j.1365-2265.2006.02432.x
To establish the incidence, pathophysiology and consequences of hyponatraemia following SAH.
02/01/2006
01:45 PM
Monocytes form a vascular barrier and participate in vessel repair after brain injury
Blood, 1 February 2006, Vol. 107, No. 3, pp. 940-946
Subpopulations of bone marrow-derived cells can be induced to assume a number of endothelial properties in vitro. However, their ability to form a functional vascular barrier has not been demonstrated. We report that human CD14+ peripheral blood monocytes cultured under angiogenic conditions develop a number of phenotypic and functional properties similar to brain microvascular endothelial cells. These cells express the tight junction proteins zonula occludens 1 (ZO-1) and occludin and form a barrier with a transcellular electrical resistance (TCER) greater than 100 ohm cm2 and low permeability to 4 kDa and 20 kDa dextrans. The TCER of the cellular barrier is decreased by bradykinin and histamine. We also demonstrate that these cells associate with repairing vasculature in areas of brain and skin injury. Our data suggest that CD14+ peripheral blood monocytes participate in the repair of the vascular barrier after brain injury.
02/01/2006
01:44 PM
Rapid Brain Discrimination of Sounds of Objects
The Journal of Neuroscience, January 25, 2006, 26(4):1293-1302
Electrical neuroimaging in humans identified the speed and spatiotemporal brain mechanism whereby sounds of living and man-made objects are discriminated. Subjects performed an "oddball" target detection task, selectively responding to sounds of either living or man-made objects on alternating blocks, which were controlled for in their spectrogram and harmonics-to-noise ratios between categories. Analyses were conducted on 64-channel auditory evoked potentials
(AEPs) from nontarget trials. Comparing responses to sounds of living versus man-made objects, these analyses tested for modulations in local AEP waveforms, global response strength, and the topography of the electric field at the scalp. In addition, the local autoregressive average distributed linear inverse solution was applied to periods of observed modulations. Just 70 ms after stimulus onset, a common network of brain regions within the auditory "what" processing stream responded more strongly to sounds of man-made versus living objects, with differential activity within the right temporal and left inferior frontal cortices. Over the 155–257 ms period, the duration of activity of a brain network, including bilateral temporal and premotor cortices, differed between categories of sounds. Responses to sounds of living objects peaked 12 ms later and the activity of the brain network active over this period was prolonged relative to that in response to sounds of man-made objects. The earliest task-related effects were observed at 100 ms poststimulus onset, placing an upper limit on the speed of cortical auditory object discrimination. These results provide critical temporal constraints on human auditory object recognition and semantic discrimination processes.
02/01/2006
01:42 PM
A Critical Role of Erythropoietin Receptor in Neurogenesis and Post-Stroke Recovery
The Journal of Neuroscience, January 25, 2006, 26(4):1269-1274
Erythropoietin (EPO) is the principal growth factor regulating the production of red blood cells. Recent studies demonstrated that exogenous EPO acts as a neuroprotectant and regulates neurogenesis. Using a genetic approach, we evaluate the roles of endogenous EPO and its classical receptor (EPOR) in mammalian neurogenesis. We demonstrate severe and identical embryonic neurogenesis defects in animals null for either the Epo or EpoR gene, suggesting that the classical EPOR is essential for EPO action during embryonic neurogenesis. Furthermore, by generating conditional EpoR knock-down animals, we demonstrate that brain-specific deletion of EpoR leads to significantly reduced cell proliferation in the subventricular zone and impaired post-stroke neurogenesis. EpoR conditional knockdown leads to a specific deficit in post-stroke neurogenesis through impaired migration of neuroblasts to the peri-infarct cortex. Our results suggest that both EPO and EPOR are essential for early embryonic neural development and that the classical EPOR is important for adult neurogenesis and for migration of regenerating neurons during post-injury recovery.
02/01/2006
01:40 PM
Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration
Neurogastroenterology and Motility 1365-2982.2005.00729.x
Oropharyngeal dysphagia is frequent during the acute phase of stroke, but most patients recover. Dysphagia is related to higher incidence of aspiration, pneumonia and death. Frequently neither clinical history nor neurological evaluation predicts the presence of aspiration. In 64 patients not recovered from severe stroke after the acute phase with clinically suspected oropharyngeal dysphagia we investigated: (i) the correlation between clinical manifestations and videofluoroscopic findings; (ii) predictive factors of aspiration and silent aspiration. Clinical examination showed that 44% had impaired gag reflex, 47% cough during oral feeding, and 13% changes in voice after swallowing. Videofluoroscopy revealed some abnormality in 87%: 53% in the oral phase and 84% in the pharyngeal phase (aspiration in 66%; half being silent). Impaired pharyngeal safety was more frequent in posterior territory lesions and patients with a history of pneumonia (P < 0.01). No correlation was found between clinical evaluation findings and presence of aspiration. Silent aspirations were more frequent in patients with previous orotracheal intubation (P < 0.05) and abnormalities in velopharyngeal reflexes (P < 0.05). We concluded that in patients not recovered from severe stroke after the acute phase and with suspected oropharyngeal dysphagia, clinical evaluation is of scant use in predicting aspiration and silent aspiration. Videofluoroscopic examination is mandatory in these patients.
01/31/2006
08:22 AM
Integration of gamma knife surgery in the management of cerebral metastases from melanoma
Melanoma Research. 16(1):51-57, February 2006.
The aim of this study was to investigate the effect of gamma knife surgery on the local control of cerebral metastases from melanoma and to assess survival. In 29 patients, 105 of 178 cerebral metastases were treated with gamma knife surgery. Only five patients had metastases confined to the brain. Of the 96 metastases with magnetic resonance imaging follow-up, 61.5% regressed by more than 50% of the pretreatment volume, 25% regressing by more than 90% and 13.5% completely. The median survival from gamma knife surgery was 5.7 months (longest survival, 38 months). In multivariate analyses, a larger number of lesions requiring treatment (P<0.001), recursive partitioning analysis class (P=0.009) and a long time interval from initial melanoma diagnosis to detection of cerebral metastases (P=0.001) influenced survival. It can be concluded that gamma knife surgery is a useful adjunct in the management of cerebral metastases from melanoma and has a significant impact on local control. Its greatest potential may be achieved in conjunction with systemic chemotherapy, especially in the presence of extracerebral metastases.
01/31/2006
08:21 AM
Lung protective ventilation in neurosurgical patients
Current Opinion in Critical Care. 12(1):3-7, February 2006.
Purpose of review: Concepts of ventilator-induced lung injury have revolutionized our approach to the ventilatory management of patients with acute lung injury and acute respiratory distress syndrome over the past 10 years. The extension of these principles to patients with brain injuries is challenging, as many of them are out of keeping with usual brain-protective management.
01/31/2006
08:19 AM
Increased Occurrence of Caspase Dependent Apoptosis in Unfavorable Neuroblastomas
American Journal of Surgical Pathology. 30(2):249-257, February 2006.
Neuroblastoma frequently shows spontaneous regression in which two distinct types of programmed cell death, ie, caspase-dependent apoptosis and H-Ras-mediated autophagic degeneration, have been suggested to play a key role. The current study was conducted to determine which of these cell suicide pathways predominated in this tumor regression. Periodic acid-Schiff (PAS) staining and immunostaining for H-Ras and for the full-length and cleaved forms of caspase-3, poly (ADP-ribose) polymerase (PARP), and lamin A were carried out on 55 archival tumor specimens. The incidence of caspase-dependent apoptosis in each tumor was quantified by cleaved lamin A staining and compared with clinicopathologic prognostic factors. Although a recent report has shown that neuroblastic cells undergoing autophagic degeneration were readily detectable by PAS and H-Ras staining, we could not confirm this result in any of our samples with the exception of one tumor. Instead, many of our neuroblastoma samples showed nonspecific PAS and Ras staining in areas of necrosis, suggesting that autophagic "degeneration" indeed corresponds to coagulation necrosis or oncosis. Unexpectedly, the incidence of caspase-dependent apoptosis was significantly correlated with indicators of a poor prognosis in these tumors, including Shimada's unfavorable histology, MYCN amplification, and a higher mitosis-karyorrhexis index, but not with factors related to tumor regression such as clinical stage and mass screening. These results indicate that neither caspase-dependent apoptosis nor autophagic "degeneration" may be involved in spontaneous neuroblastoma regression. This suggests that other mechanisms, perhaps such as tumor maturation, may be responsible for this phenomenon.
01/31/2006
08:17 AM
Omega 3 fatty acid for the prevention of dementia
The Cochrane Library, Issue 1, 2006. Chichester, UK
Accruing evidence from observational and epidemiological studies suggests an inverse relationship between dietary intake of omega 3 polyunsaturated fatty acid (PUFA) and risk of dementia. Postulated mechanisms that might qualify omega 3 PUFA as an interventional target for the primary prevention of dementia include its anti-atherogenic, anti-inflammatory, anti-oxidant, anti-amyloid and neuroprotective properties.
01/31/2006
08:16 AM
Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury
The Cochrane Library, Issue 1, 2006. Chichester, UK
High intracranial pressure (ICP) is the most frequent cause of death and disability after severe traumatic brain injury (TBI). High ICP is treated by general maneuvers (normothermia, sedation etc) and a set of first line therapeutic measures (moderate hypocapnia, mannitol etc). When these measures fail to control high ICP, second line therapies are started. Among these, second line therapies such as barbiturates, hyperventilation, moderate hypothermia or removal of a variable amount of skull bone (known as decompressive craniectomy) are used.
01/31/2006
08:14 AM
Astrocytoma with pilomyxoid features presenting in an adult
Neuropathology Volume 26 Page 89 - February 2006
Pilomyxoid histology is presently considered to occur in pediatric brain tumors. We report an astrocytoma with pilomyxoid features presenting in an adult and discuss its relationship to both the established childhood pilomyxoid astrocytoma (PMA) and recently reported tanycytoma. A 28-year-old man with medically intractable seizures presented for surgical evaluation. MRI revealed a discrete lesion in the right amygdala/uncus region. The patient elected for craniotomy with stereotactic temporal lobe resection and excision of the lesion. Postoperatively, the patient has done well. At 30-month follow up, he is seizure free and without evidence of tumor recurrence. We report an astrocytoma with pilomyxoid features presenting in an adult, illustrating that while this histological pattern is most commonly seen in children, it may also affect older individuals. Recognition of this enigmatic pattern in adult gliomas expands the currently accepted epidemiology for this lesion.
01/31/2006
08:13 AM
Markers of Inflammation and Infection Influence the Outcome of Patients With Baseline Asymptomatic Carotid Lesions
Stroke. 2006;37:482.
It is still in debate whether the evaluation of markers of infection and inflammation may be of importance for cerebrovascular and cardiovascular prevention, and we aimed to investigate this field in a prospective 5-year clinical follow-up study in patients with early stages of atherosclerosis.
01/31/2006
08:11 AM
Xenon Provides Short Term Neuroprotection in Neonatal Rats When Administered After Hypoxia Ischemia
Stroke. 2006;37:501.
Brain injury after hypoxic-ischemic insults evolves via an apoptotic/necrotic cascade. Glutamate over release and N-methyl-D-aspartate (NMDA) receptor over activation (excitotoxicity) are believed to trigger this process. Xenon is a nontoxic anesthetic gas that reduces neurotransmitter release and functionally antagonizes NMDA receptors. Administering xenon to hypoxic-ischemic newborns might be clinically effective if the neurotoxic processes continue evolving after delivery. We sought to determine whether xenon administration after the initial hypoxic-ischemic insult was neuroprotective.
01/31/2006
08:10 AM
Magnetic Resonance Angiography of Cerebral Arteries After Neonatal Venoarterial and Venovenous Extracorporeal Membrane Oxygenation
Stroke. 2006;37:e15.
In newborns with severe respiratory failure, extracorporeal membrane oxygenation (ECMO) has been proven to improve survival. With venoarterial ECMO, the right common carotid artery is ligated, whereas with venovenous ECMO, this carotid artery remains intact. The authors present the magnetic resonance angiography (MRA) evaluation of cerebral hemodynamics in a case of venoarterial and a case of venovenous ECMO.
01/31/2006
08:09 AM
Stroke and Encephalopathy After Cardiac Surgery
Stroke. 2006;37:562.
As a result of advances in surgical, anesthetic, and medical management, cardiac surgery can now be performed on older, sicker patients, some of whom have had prior cardiac interventions. As surgical mortality has declined in recent years, attention has focused on the complications of stroke and encephalopathy after cardiac surgery.
01/31/2006
08:07 AM
The Impact of Functional Status at Three Months on Long Term Survival After Spontaneous Intracerebral Hemorrhage
Stroke. 2006;37:487.
Few studies have assessed long-term prognosis and risk factors for death after spontaneous intracerebral hemorrhage (ICH). Patients who survive the acute phase may run different prognoses, depending on their disability, treatment, and lifestyle. The present study was performed to find out the predictors for long-term mortality after ICH.
01/31/2006
08:06 AM
The Impact of Postoperative Nasal Packing on Sleep Disordered Breathing and Nocturnal Oxygen Saturation in Patients with Obstructive Sleep Apnea Syndrome
Anesth Analg 2006;102:615-620
Nasal septum surgery is frequently performed to establish a functional nasal airway. In these patients obstructive sleep apnea syndrome (OSAS) is frequently present. Although patients with OSAS are at increased risk for hypoxemia, the impact of postoperative nasal packing (PNP) on sleep-disordered breathing and oxygen desaturations in patients with OSAS is unknown. We consecutively investigated 40 patients undergoing endonasal surgery receiving PNP. Fifteen of these patients had previously diagnosed OSAS (Group 2) and 25 did not (Group 1). In the control group, 12 healthy patients underwent elective ear or neck surgery without PNP. During the preoperative and postoperative nights, we continuously measured oronasal flow, thoracoabdominal movements, and oxygen saturation.
01/31/2006
08:06 AM
Stroke and Encephalopathy After Cardiac Surgery
Stroke. 2006;37:562.
As a result of advances in surgical, anesthetic, and medical management, cardiac surgery can now be performed on older, sicker patients, some of whom have had prior cardiac interventions. As surgical mortality has declined in recent years, attention has focused on the complications of stroke and encephalopathy after cardiac surgery.
01/31/2006
08:04 AM
A Randomized Controlled Trial of Supervised Versus Unsupervised Exercise Programs for Ambulatory Stroke Survivors
Stroke. 2006;37:476.
Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors. This study compared the effectiveness of a 10-week supervised strengthening and conditioning program (supervised) with a 1-week supervised instruction program followed by a 9-week unsupervised home program (unsupervised) and evaluated retention of changes at 6 months and 1 year after program completion.
01/31/2006
08:04 AM
Cerebral Microhemorrhage
Stroke. 2006;37:550.
With the advent of modern MRI imaging techniques, cerebral microhemorrhages have been increasingly recognized on gradient-echo (GE) or T2*-weighted MRI sequences in different populations. However, in clinical practice, their diagnostic value, associated risk, and prognostic significance are often unclear. This review summarizes the
pathophysiology, differential diagnosis, epidemiology, and clinical significance of cerebral
microhemorrhages.
01/31/2006
08:02 AM
Comprehensive Transcriptome of Proteases and Protease Inhibitors in Vascular Cells
Stroke. 2006;37:537.
Smooth muscle cells, endothelial cells, and macrophages are essential components of the
vasculature, of which the homeostatic gene expression participate importantly in the maintenance of vascular wall integrity. The pathogenesis of vascular diseases, such as cerebral
ischemia, atherosclerosis, and abdominal aortic aneurysms, often associates with inflammation and altered gene expression, including proteolytic enzymes that play multiple and important roles in extracellular matrix degradation, cell proliferation and migration, and latent enzyme or growth factor activation.
01/31/2006
08:01 AM
Classification and Pathogenesis of Cerebral Hemorrhages After Thrombolysis in Ischemic Stroke
Stroke. 2006;37:556.
Brain hemorrhage after ischemic stroke is a serious complication of treatment; however, its pathology is poorly understood. A classification based on brain imaging may help to better understand and avoid causal factors.
01/31/2006
08:00 AM
Family History of Stroke Does Not Predict Risk of Stroke After Transient Ischemic Attack
Stroke. 2006;37:544.
Animal models suggest a genetic contribution to cerebral susceptibility to
ischemia. Family history of stroke (FHxstroke) is a risk factor for ischemic stroke, but there is significant confounding by heritability of hypertension and other intermediate phenotypes, and it is uncertain whether genetic factors have a direct independent influence on cerebral susceptibility to ischemia in man.
01/31/2006
07:59 AM
Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack
Stroke. 2006;37:577.
The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for
cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke. Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen
ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations.
01/28/2006
11:06 AM
Intracranial Compartment Volumes in Normal Pressure Hydrocephalus Volumetric Assessment versus Outcome
American Journal of Neuroradiology 27:76-79, January 2006
Although enlargement of the cerebral ventricles plays a central role in the diagnosis of normal pressure hydrocephalus
(NPH), there are no reports on the use of volumetric assessment to distinguish between patients who respond to ventriculoperitoneal shunt surgery and those who do not. The purpose of this study is to explore the association between preoperative intracranial compartment volumes and postoperative improvement.
01/28/2006
11:04 AM
Signs and Symptoms of Cerebrospinal Fluid Shunt Malfunction in the Pediatric Emergency Department
Pediatric Emergency Care 22(1):28-34, January 2006.
Pediatric patients with cerebrospinal fluid shunts frequently present to the emergency department for evaluation of possible shunt malfunction. Most shunt studies appear in the neurosurgical literature. To our knowledge, none have reviewed presenting signs and symptoms of shunt malfunction in patients who present to the pediatric emergency department. The study objective was to evaluate the medical record of children with cerebrospinal fluid shunts who presented to a pediatric emergency department to determine if any signs and/or symptoms were predictive of shunt malfunction.
01/28/2006
11:03 AM
Neuroprotection against ischaemic brain injury by a GluR6 9c peptide containing the TAT protein transduction sequence
Brain 2006 129(2):465-479; doi:10.1093/brain/awh700
It is well documented that N-methyl-D-aspartate and -amino-3-hydroxy-5-methyl-4-isoxazole propionate receptors play a pivotal role in ischaemic brain injury. Recent studies have shown that kainate (KA) receptors are involved in neuronal cell death induced by seizure, which is mediated by the GluR6•PSD-95•MLK3 signalling module and subsequent c-Jun N-terminal kinase
(JNK) activation.
01/28/2006
11:02 AM
The Significance of Various Blood Pressure Indices for Long Term Stroke Coronary Heart Disease and All Cause Mortality in Men
Stroke. 2006;37:358.
Studies of blood pressure (BP) indices as disease predictors have offered conflicting conclusions. We compare pulse pressure (PP), systolic BP
(SBP) and diastolic BP (DBP), and mean arterial pressure (MAP) as risk markers for long-term mortality with emphasis on stroke.
01/28/2006
11:01 AM
The Lifetime Risk of Stroke
Stroke. 2006;37:345.
The lifetime risk (LTR) of stroke has not been reported for the United States population; such data would assist public education and health planning.
01/28/2006
11:00 AM
White matter damage on diffusion tensor imaging correlates with age related cognitive decline
NEUROLOGY 2006;66:217-222
Damage to white matter tracts, resulting in "cerebral disconnection," may underlie age-related cognitive decline.
01/28/2006
10:58 AM
Surviving glioblastoma for more than 5 years The patient's perspective
NEUROLOGY 2006;66:239-242
The authors performed a comprehensive analysis of the functional outcome of 10 patients who had survived 5 years from a diagnosis of
glioblastoma. Neurologic deficits were mild in most patients, but neuropsychological testing demonstrated cognitive deficits in all patients. Depression and anxiety were common. Although most patients thought that their social functioning and work ability were impaired, little reduction in overall quality of life was perceived.
01/28/2006
10:56 AM
A Comparison of Depressive Symptoms in Stroke and Primary Care Applying Rasch Models to Evaluate the Center for Epidemiologic Studies Depression Scale
Value in Health Online Early doi:10.1111/j.1524-4733.2006.00082.x
Clinical trials and community-based studies often include the Center for Epidemiologic Studies-Depression scale
(CES-D) as a measure of depression outcome. We compared responses to symptom-related items on the
CES-D by depressed stroke and primary-care patients for several purposes: 1) to illustrate the use of Item Response Theory
(IRT)-based (Rasch) models for comparing scale functioning across different patient subgroups; and 2) to inform clinicians and outcome researchers about scale functioning and depressive symptomatology in stroke- compared with primary care-based depression.
01/28/2006
10:55 AM
Global brain atrophy after unilateral parietal lesion and its prevention by erythropoietin
Brain 2006 129(2):480-489; doi:10.1093/brain/awh703
In humans, neurotrauma is suspected to cause brain atrophy and accelerate slowly progressive neurodegenerative disorders, such as Alzheimer's disease or schizophrenia. However, a direct link between brain injury and subsequent delayed global neurodegeneration has remained elusive. Here we show that juvenile (4-week-old) mice that are given a discrete unilateral lesion of the parietal cortex, develop to adulthood without obvious clinical symptoms.
01/28/2006
10:54 AM
Cerebellar damage produces selective deficits in verbal working memory
Brain 2006 129(2):306-320; doi:10.1093/brain/awh685
The cerebellum is often active in imaging studies of verbal working memory, consistent with a putative role in articulatory rehearsal. While patients with cerebellar damage occasionally exhibit a mild impairment on standard neuropsychological tests of working memory, these tests are not diagnostic for exploring these processes in detail. The current study was designed to determine whether damage to the cerebellum is associated with impairments on a range of verbal working memory tasks, and if so, under what circumstances.
01/28/2006
10:53 AM
Spatial neglect a vestibular disorder
Brain 2006 129(2):293-305; doi:10.1093/brain/awh698
The phenomenon of spatial neglect after right brain damage greatly helps our understanding of the normal mechanisms of directing and maintaining spatial attention, of spatial orientation, and the characteristics of neural representation of space.
01/28/2006
10:52 AM
Amygdaloid kindled seizures can induce functional and pathological changes in thymus of rat Role of the sympathetic nervous system
Neurobiology of Disease Volume 21, Issue 1 , January 2006, Pages 127-137
The present study sought to determine the effects of long-term kindled seizures of the basal amygdala upon immune function in rat, utilizing the thymus, as a principal target for study. Histopathology from kindled Sprague–Dawley rats revealed the presence of epithelial cell thymoma in 70% of these rats.
01/28/2006
10:50 AM
Astrocytoma with pilomyxoid features presenting in an adult
Neuropathology Volume 26 Page 89 - February doi:10.1111/j.1440-1789.2006.00641.x
Pilomyxoid histology is presently considered to occur in pediatric brain tumors. We report an astrocytoma with pilomyxoid features presenting in an adult and discuss its relationship to both the established childhood pilomyxoid astrocytoma (PMA) and recently reported tanycytoma.
01/28/2006
10:49 AM
Seizures and their outcome in progressive multifocal leukoencephalopathy
NEUROLOGY 2006;66:262-264
Seizures are not expected in progressive multifocal leukoencephalopathy (PML), a condition considered to be restricted to the white matter. Review of medical records of 89 patients with possible or proven PML showed an 18% prevalence of seizures. Seizures usually responded well to treatment and did not affect survival. The presence of PML lesions immediately adjacent to the hemispheric cortex was the only risk factor associated with seizures in this population.
01/28/2006
10:48 AM
Grey matter heterotopia what EEG fMRI can tell us about epileptogenicity of neuronal migration disorders
Brain 2006 129(2):366-374; doi:10.1093/brain/awh710
Grey matter heterotopia are commonly associated with refractory epilepsy. Depth electrodes recordings have shown that epileptiform activity can be generated within these lesions, and also at a distance in the neocortex. Heterotopia seem to be part of a more complex circuitry involving also the surrounding and distant cerebral cortex. Blood oxygenation level-dependent (BOLD) changes to interictal spikes using continuous EEG and functional MRI (EEG-fMRI) can help to understand non-invasively the mechanisms of epileptogenicity in these patients.
01/28/2006
10:47 AM
Left hippocampal pathology is associated with atypical language lateralization in patients with focal epilepsy
Brain 2006 129(2):346-351; doi:10.1093/brain/awh694
It is well recognized that the incidence of atypical language lateralization is increased in patients with focal epilepsy. The hypothesis that shifts in language dominance are particularly likely when epileptic lesions are located in close vicinity to the so-called language-eloquent areas rather than in more remote brain regions such as the hippocampus has been challenged by recent studies.
01/28/2006
10:45 AM
Association of Phosphodiesterase 4D With Ischemic Stroke
Stroke. 2006;37:371.
The Phosphodiesterase 4D (PDE4D) gene was reported recently to be associated with ischemic stroke in an Icelandic population. The association was found predominately with large vessel and cardioembolic stroke. However, 2 recent reports were unable to confirm this association, although a trend toward association with cardioembolic stroke was reported. None of the reports included significant proportions of blacks. We tested for genotype and haplotype association of polymorphisms of the PDE4D gene with ischemic stroke in a population-based, biracial, case-control study.
01/28/2006
10:44 AM
Accuracy of Color Duplex Ultrasound Diagnosis of Spontaneous Carotid Dissection Causing Ischemia
Stroke. 2006;37:377.
Spontaneous dissection of the cervical internal carotid artery (sICAD) is mainly assessed with MRI and magnetic resonance angiography (MRA), which are not always at hand. In contrast, color duplex sonography (CDS) is readily available. We undertook this prospective study to examine the accuracy of CDS to diagnose sICAD in patients with first carotid territory ischemia.
01/28/2006
10:41 AM
Aneurysmal Subarachnoid Hemorrhage
New England Journal of Medicine Volume 354:387-396 January 26, 2006 Number 4
Nontraumatic subarachnoid hemorrhage is a neurologic emergency characterized by the extravasation of blood into the spaces covering the central nervous system that are filled with cerebrospinal fluid. The leading cause of nontraumatic subarachnoid hemorrhage is rupture of an intracranial aneurysm, which accounts for about 80 percent of cases and has a high rate of death and complications.1 Nonaneurysmal subarachnoid hemorrhage, including isolated perimesencephalic subarachnoid hemorrhage, occurs in about 20 percent of cases and carries a good prognosis with uncommon neurologic complications.2 This review focuses on aneurysmal subarachnoid hemorrhage.
01/28/2006
10:39 AM
Recovery from sports concussion in high school and collegiate athletes
Source: Brain Injury Volume: 20 Number: 1 Page: 33 -- 39
Introduction : Neuropsychological testing is a valuable tool in concussion diagnosis and management. ImPACT, a computerized neuropsychological testing program, consists of eight cognitive tasks and a 21-item symptom inventory. Method : ImPACT was used to examine the cognitive performance of 104 concussed athletes at baseline, 2, 7 and 14 days post-injury. Dependent measures included composite scores from the ImPACT computerized test battery, as well as a total symptom score from the Post-Concussion Symptom Scale.
01/28/2006
10:38 AM
Clinical Consequences of Infection in Patients With Acute Stroke
Stroke. 2006;37:461.
It is unsettled whether stroke-associated infection (SAI) is an independent prognostic factor, and a recent clinical trial failed to show that antibiotic prophylaxis prevented SAI. Contrarily, this trial suggested that antibiotic prophylaxis impaired clinical recovery. We sought to evaluate the predisposing factors and clinical consequences of SAI to gather additional insight on the need of exploring other antibiotics in acute stroke.
01/28/2006
10:37 AM
Eliciting Information on Differential Sensation of Heat in Those With and Without Poststroke Aphasia Using a Visual Analogue Scale
Stroke. 2006;37:471.
Aphasia can result in an inability to communicate the presence, location, or intensity of pain. Although visual analogue scales (VASs) exist, it is unknown whether they are useful in assessing pain in individuals with aphasia. The objective was to determine whether those with poststroke aphasia could respond differentially to thermal stimuli of varying intensities using a standardized VAS.
01/28/2006
10:35 AM
Are There Patients With Acute Ischemic Stroke and Atrial Fibrillation That Benefit From Low Molecular Weight Heparin
Stroke. 2006;37:452.
Treatment doses of heparins are not recommended for acute ischemic stroke. Despite this, their use in this setting is widespread. We investigated whether subgroups of patients with acute ischemic stroke and atrial fibrillation, identified by clinical, hemostatic (D-dimer, prothombin fragments1+2 [F1+2], soluble fibrin monomer), or inflammatory (C-reactive protein [CRP]) variables might have a differential response to low molecular weight heparin (LMWH) over aspirin. In addition, we sought to identify factors associated with a poor clinical outcome at 3 months.
01/28/2006
10:33 AM
Low Dose Aspirin for Prevention of Stroke in Low Risk Patients With Atrial Fibrillation
Stroke. 2006;37:447.
Although the efficacy of anticoagulant therapy for primary prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) has been established, efficacy of antiplatelet therapy for low-risk patients is disputable in Japanese patients because of the frequent hemorrhagic complications. We examined the efficacy and safety of aspirin therapy in Japanese patients with NVAF in a prospective randomized multicenter trial.
01/28/2006
10:32 AM
Bipolar deep brain stimulation permits routine EKG, EEG, and polysomnography
NEUROLOGY 2006;66:268-270
As the population of patients treated with deep brain stimulation (DBS) grows and the patients age, more will require routine or emergent electrophysiologic tests. DBS artifact may render these uninterpretable, whereas stopping DBS may release symptoms that confound evaluation. The authors find that monopolar, but not bipolar, stimulation produces significant artifact during EKG, EEG, and polysomnography.
01/28/2006
10:31 AM
Antiplatelet use after intracerebral hemorrhage
NEUROLOGY 2006;66:206-209
The authors reviewed data from consecutive survivors of primary intracerebral hemorrhage enrolled in a single-center prospective cohort study. Survivors were followed by telephone interview; recurrent intracerebral hemorrhage and post–index antiplatelet agent use and duration were recorded. Cox proportional hazards models was used with antiplatelet agent exposure as a time-dependent variable to assess the effect of antiplatelet agent use on recurrent intracerebral hemorrhage, stratified by lobar and deep hemispheric location.
01/28/2006
10:29 AM
Longitudinal cognitive changes in traumatic brain injury
NEUROLOGY 2006;66:187-192
Two hundred ten patients with substantial TBI of variable severity were initially assessed between 1966 and 1972 at Turku University Hospital (Finland). Of these, 61 patients could be studied using the same assessments in the follow-up examination, on average 30 years after the TBI. The results of the follow-up assessment were also compared with an age- and education-matched control group. During each examination, patients were assessed with five subtests of the Wechsler Adult Intelligence Scale, three tests for episodic memory, and the general cognitive decline was determined.
01/26/2006
01:15 PM
Impaired sustained attention and error awareness in traumatic brain injury Implications for insight
Neuropsychological Rehabilitation Issue: Volume 15, Number 5 / December 2005 Pages: 569 - 587
The processes of error awareness and sustained attention were investigated in 18 traumatic brain injury (TBI) individuals and 16 matched control participants. In Experiment 1, we found that: (1) in comparison to controls, TBI participants displayed reduced sustained attention and awareness of error during the Sustained Attention to Response Task; (2) degree of error awareness was strongly correlated with sustained attention capacity, even with severity of injury partialed out; and (3) that error feedback significantly reduced errors. We replicated the finding of a correlation between error awareness and sustained attention capacity in Experiment 2 with a separate sample of 19 TBI participants and 20 controls. We conclude that TBI leads to impaired sustained attention and error awareness. The finding of a significant relationship between these two deficits in TBI suggests there may be a link between these two processes. Feedback on error improves sustained attention performance of control and TBI participants.
01/26/2006
01:12 PM
Recovery at One Year Following Isolated Traumatic Brain Injury A Western Trauma Association Prospective Multicenter Trial
Journal of Trauma-Injury Infection & Critical Care. 59(6):1298-1304, December 2005
Background: Age has been shown to be a primary determinant of survival following isolated traumatic brain injury (TBI). We have previously reported that patients >=65 years who survived mild TBI have decreased functional outcome at 6 months compared with younger patients. The purpose of this study was to further investigate the effect of age on outcome at 1 year in all patients surviving isolated TBI.
01/26/2006
01:10 PM
Analysis of Head Injury Admission Trends in an Urban American Pediatric Trauma Center
Journal of Trauma-Injury Infection & Critical Care. 59(6):1292-1297, December 2005
Background: Head injury is the leading cause of death in children. Child safety legislation and risk-specific intervention programs have flourished to mitigate the incidence of injury to children. This analysis documents the trend in head injury to children in a specific institution.
01/26/2006
01:07 PM
Clinical Predictors of Cerebrovascular Occlusion for Patients Presenting With Acute Stroke
Journal of Stroke Volume 15, Issue 1, Pages 30-33 (January 2006)
Objective: We sought to determine clinical predictors of vascular occlusion in patients with stroke. Methods: From November 1994 to December 1999, 88 patients who were thrombolytic candidates and seen within 6 hours of stroke symptom onset had cerebral angiography. The Oxford Community Stroke Project clinical classification system, admission National Institutes of Health Stroke Scale score, and time from symptom onset until angiography were used to predict vascular occlusion. Results: In all, 79% of patients with total anterior circulation infarctions and 73% with partial anterior circulation infarctions had vascular occlusions, whereas only 29% with lacunar infarcts had occlusion. Strokes were more severe in patients with occlusion than in those without occlusion. Time to angiography was also associated with vascular occlusion.
01/26/2006
01:06 PM
Acute Aortic Dissection Presenting as a Neurologic Disorder
Journal of Stroke Volume 15, Issue 1, Pages 26-29 (January 2006)
We present 3 patients who had dissections of the aorta that resulted in neurologic disorders. One patient had an altered mental state and developed cardiopulmonary arrest. Two patients had acute hemimotor findings. In 1 of these 2 cases, progression to cardiopulmonary arrest occurred. We discuss the possibility of neurologic disorder, especially acute ischemic stroke, caused by aortic dissection with reviewed reports, and emphasize that thrombolytic therapy may not be easily indicated for acute-stage stroke. We also mention the usefulness of noninvasive techniques, such as chest X-ray, transesophageal echocardiography, color coded Doppler echocardiography, and carotid ultrasound, for accurate diagnosis of the aortic dissection with neurologic deficit.
01/26/2006
01:04 PM
Perfusion Computed Tomography for the Indication of Percutaneous Transluminal Reconstruction for Acute Stroke
Journal of Stroke Volume 15, Issue 1, Pages 18-25 (January 2006)
Perfusion computed tomography (CT) was performed in patients with acute-stage stroke to assess the indications for percutaneous transluminal reconstruction (PTR). This study included 59 patients admitted within 8 hours of onset of stroke in whom initial CT demonstrated no ischemic changes. Multiple regions of interest (ROIs) were selected in the ischemic lesions, and the ratios of cerebral blood flow (CBF) and cerebral blood volume (CBV) in the ROIs were calculated and compared to with those in the same location in the opposite hemisphere. The ischemic boundaries for CBF and CBV were analyzed in 29 patients treated conservatively. PTR was performed in 30 patients without visually decreased CBV. Some of the patients with visually evaluated abnormal regional mean transit time, decreased regional CBF, and normal regional CBV developed infarction, but others did not.
01/26/2006
01:03 PM
Reference Table Predicting the Outcome of Subarachnoid Hemorrhage in the Elderly Stratified by Age
Journal of Stroke Volume 15, Issue 1, Pages 14-17 (January 2006)
Although the recovery from an aneurysmal subarachnoid hemorrhage (SAH) is hampered by advanced age, the impact of age on surgical outcome has not been evaluated quantitatively. We studied 168 patients with SAH treated between 2000 and 2002. Study variables included sex, age, location of aneurysm, preoperative Glasgow coma scale (GCS) score, and presence of intracerebral
hematoma, vasospasm, or hydrocephalus. Univariate and multiple logistic regression analyses were applied to test the effect of age and preoperative GCS scores on the likelihood of a favorable outcome. Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] = 1.109; 95% confidence interval [CI] = 1.051–1.169) and decrements of preoperative GCS score (OR = 0.69; 95% CI = 0.586–0.812) were inversely associated with the likelihood of a favorable outcome. Based on the results, we generated a reference table that depicts the outcome based on the preoperative GCS score stratified by age. This simple reference table is useful in predicting surgical outcome in emergent situations. This study indicated that a 10-year advance in age is equivalent to a 2.3-point reduction in the GCS score.
01/26/2006
01:01 PM
Increased von Willebrand Factor in Acute Stroke Patients With Atrial Fibrillation
Journal of Stroke Volume 15, Issue 1, Pages 1-7 (January 2006)
Plasma level of von Willebrand factor (vWF) is a useful marker not only for endothelial dysfunction, but also for left atrial thrombogenesis. We measured plasma levels of vWF antigen and other coagulation and fibrinolysis markers in 183 consecutive patients with acute ischemic stroke and compared these data between patients with and without atrial fibrillation (AF). vWF correlated with severity, outcome, and infarct size and were significantly higher in the AF group than in the non-AF group. The positive correlations of vWF with plasmin-a2 plasmin inhibitor complex and soluble fibrin monomer complex, and higher levels of vWF in patients with than without spontaneous echo contrast, indicate thrombogenesis in the left atrium. Plasma levels of vWF may reflect thrombogenesis in patients with AF.
01/26/2006
08:20 AM
Neurocognitive fitness in the sub acute stage after mild TBI: The effect of age
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 161 - 165
Age is assumed to be a negative prognostic factor in recovery from moderate-to-severe traumatic brain injury (TBI). Little is known on cognitive performance after mild TBI in relation to age in the sub-acute stage after injury.
01/26/2006
08:19 AM
Human spatial navigation deficits after traumatic brain injury shown in the arena maze a virtual Morris water maze
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 189 - 203
Survivors of traumatic brain injury (TBI) often have spatial navigation deficits. This study examined such deficits and conducted a detailed analysis of navigational behaviour in a virtual environment.
01/26/2006
08:17 AM
Prediction of functional rehabilitation outcomes in clients with stroke
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 205 - 211
To evaluate the validity of the Neurobehavioral Cognitive Status Examination (NCSE or Cognistat) and to determine its effects in order to estimate the functional outcomes of survivors with stroke.
01/26/2006
08:15 AM
Post anoxic myoclonus A case presentation and review of management in the rehabilitation setting
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 213 - 217
Post-anoxic myoclonus is a rare movement disorder manifested by diffuse action-triggered jerking movements that may result in significant disability. The incidence of this disorder is not clearly established, but over 122 cases have so far been reported in the literature. The pathogenesis is not entirely known, although it has been hypothesized that particular susceptibility of the Purkinjie cells of cerebellum to anoxic injury may play a key role. A case is presented of an independently living 60-year-old woman admitted to the rehabilitation unit with diffuse myoclonus after sustaining a cardio-pulmonary arrest. She presented with severe jerking movements in all extremities with startle to noise and exacerbations upon attempting any purposeful actions. The patient's myoclonus was controlled by a variety of anti-epileptic medications. The patient initially responded to a combination of divalproex sodium and zonisamide, but relapsed in several weeks, requiring addition of levetriacetam and clonazepam. At a 1-year follow-up she demonstrated a significant improvement in ambulation and self-care activities. This case illustrates that, although patients with post-anoxic myoclonus cannot be fully cured, their quality of life can be significantly improved by rehabilitation interventions.
01/26/2006
08:14 AM
Reduced daytime activity in patients with acquired brain damage and apathy A study with ambulatory actigraphy
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 157 - 160
Apathy is difficult to assess in clinical practice. Ambulatory actigraphy was used with the aim to measure locomotor activity during the daytime as a correlate of self-initiated action in brain-damaged patients with apathy.
01/26/2006
08:13 AM
A study investigating the effects of Tai Chi Chuan Individuals with traumatic brain injury compared to controls
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 151 - 156
To explore the effects of a 6-week course in Tai Chi associated with traumatic brain injury (TBI) symptoms.
01/26/2006
08:11 AM
Exploring eye movement analysis as a measure of selective visual attention in brain injured individuals
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 143 - 150
Primary objective: To investigate the utility of using a new method of assessment for deficits in selective visual attention (SVA).
01/26/2006
08:10 AM
Aquatics health-promoting self care behaviours and adults with brain injuries
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 133 - 141
To determine the effect of an aquatic programme on the health promoting behaviours of adults with brain injuries.
01/26/2006
08:09 AM
Mild traumatic brain injury and anxiety sequelae A review of the literature
Brain Injury Issue: Volume 20, Number 2 / February 2006 Pages: 117 - 132
There is scattered but significant psychological and neuropsychological evidence to suggest that mild traumatic brain injury (mild TBI) plays a notable role in the emergence and expression of anxiety. Conversely, there is also empirical evidence to indicate that anxiety may exert a pronounced impact on the prognosis and course of recovery of an individual who has sustained a mild TBI. Although the relationship between mild TBI and anxiety remains unclear, the present body of research attempts to elucidate a number of aspects regarding this topic. Overall, the mild TBI research is rife with inconsistencies concerning prevalence rates, the magnitude and implications of this issue and, in the case of PTSD, even whether certain diagnoses can exist at all. This review obviates the need for greater consistencies across studies, especially between varying disciplines, and calls for a shift from studies overly focused on categorical classification to those concerned with dimensional conceptualization.
01/26/2006
07:58 AM
Improvement patterns among survivors of brain injury Three case examples documenting the effectiveness of memory compensation strategies
Brain Injury Issue: Volume 20, Number 1 / January 2006 Pages: 101 - 109
Three case examples illustrate possible patterns of improved functioning that may emerge as survivors of traumatic brain injury
(TBI) attempt compensation for persistent memory deficits impeding independent living. The task selected for report was independence in remembering to take regularly-prescribed medications. Strategies applied to promote learning included use of written reminders and use of two assistive technology (AT) devices—a wristwatch alarm
(WatchMinder®) and a digital voice recorder and alarm system (Voice Craft™). With participation in the intervention
programme, two of the three individuals demonstrated increased independence in remembering to take medications; the third did not. The case examples illustrate varying responses of people with TBI to intervention using compensatory strategies and AT devices. Professionals and caretakers working with survivors must recognize the uniqueness of each survivor, must adjust intervention programmes accordingly and must be willing to persist in trying to increase functional independence repeatedly for many years post-injury.
01/26/2006
07:53 AM
Who benefits Outcome following a coping skills group intervention for traumatically brain injured individuals
Brain Injury Issue: Volume 20, Number 1 / January 2006 Pages: 1 - 13
Primary objective: To investigate the variables associated with positive psychological outcome following a group intervention for 33 individuals with traumatic brain injury.
01/26/2006
07:51 AM
Endovascular Treatment of Intracranial Aneurysms with a Branch Arising from the Sac
American Journal of Neuroradiology 27:142-147, January 2006
The endovascular treatment (EVT) of intracranial aneurysms is no more limited by the presence of a branch at the neck or by the neck width. Saccular aneurysms with a branch arising from the sac, however, are mostly candidates for surgery rather than embolization. We prospectively evaluated the feasibility and safety of the EVT in such cases.
01/26/2006
07:50 AM
Factors Associated With In Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients
Published online before print January 5, 2006
The prospective trials evaluating the safety and efficacy of intravenous tissue plasminogen activator have generally been conducted at academic medical centers and community hospitals with an institutional commitment to stroke care. Relatively little is known about the safety of this therapy as it is used in the community. We therefore examined outcomes in acute stroke patients treated with thrombolysis using the largest discharge database available in the United States for the years 1999 to 2002.
01/26/2006
07:49 AM
Endovascular Recanalization Therapy in Acute Ischemic Stroke
Published online before print December 22, 2005
To assess the outcome in acute ischemic stroke patients not eligible for systemic thrombolysis (outside the 3-hour time window, after surgery, or on anticoagulant) undergoing endovascular recanalization therapy (ERT) at the Columbia University Medical Center (CUMC) and to determine US nationwide usage and outcome of ERT in acute ischemic stroke.
01/26/2006
07:47 AM
Early recombinant activated factor VII for intracerebral hemorrhage reduced hematoma growth and mortality while improving functional outcomes
Critical Care 2006, 10:304 doi:10.1186/cc3978
Recombinant activated factor VIIa (rFVIIa) can effectively reduce hematoma growth and improve outcomes when given within 4 hours of symptom onset in patients with acute intracerebral hemorrhage.
01/26/2006
07:45 AM
Errors in self report of post traumatic stress disorder after severe traumatic brain injury
Source: Brain Injury Volume: 20 Number: 1 Page: 93 -- 99
Abstract: Assessing PTSD by questionnaire can lead to false positive diagnosis after severe traumatic brain injury. Sumpter and McMillan, reported quantitative data on 34 people with severe TBI; 59% were PTSD 'cases' by questionnaire assessment, but only 3% using a structured interview. The present paper describes ways in which these individuals made errors on questionnaires. Some did not follow questionnaire instructions because of inattention and concrete thinking or instead reported effects of brain injury. Symptom overlap between TBI and PTSD, including insomnia, irritability and impaired concentration can cause errors. Brain injury can also provoke curiosity about loss of memory (during coma, retrograde and post-traumatic amnesia), decreased participation, social withdrawal and difficulty adjusting to injury that may be mistaken for fear-associated PTSD symptoms. Assessment of PTSD by questionnaire can lead to erroneous conclusions and factors related to brain injury must be carefully considered when investigating PTSD.
01/26/2006
07:44 AM
Co morbid traumatic brain injury and substance use disorder Childhood predictors and adult correlates
Source: Brain Injury Volume: 20 Number: 1 Page: 41 -- 49
Primary objective : To examine demographic factors, childhood experiences and behaviour problems and adult psychopathology associated with a history of adult traumatic brain injury (TBI) with unconsciousness in patients with substance use disorders (SUD). Design and methods : Voluntary patients ( n ?=?550) undergoing treatment for SUD were compared for clinical and demographic variables based on report of TBI. Results : Among the 218 (40%) patients reporting TBI, 61% were men. Childhood conduct problems and loss of a parent were strongly associated with adult TBI. Patients with TBI had more severe SUD and higher rates of depressive and anxiety symptoms, somatic concerns, physical trauma, attempted suicide and Antisocial Personality Disorder. Conclusions : Men have a higher rate of TBI than women, but women with SUD have an increased relative risk of TBI compared to women in the general population. Childhood conduct problems and loss of a parent in childhood may predict adult risk-taking behaviour that leads to TBI in patients with SUD. TBI is associated with higher rates of psychopathology in patients with SUD.
01/26/2006
07:43 AM
Executive dysfunction and domestic violence
Source: Brain Injury Volume: 20 Number: 1 Page: 61 -- 66
Primary objective : To replicate previous studies which have reported a high prevalence of traumatic brain injury (TBI) in partner-abusive men and to extend research in this area by determining the prevalence of executive dysfunctions, which have been linked with both TBI and violent behaviour. Research design : Thirty-eight men with criminal convictions for violence and who were receiving treatment for abusing their partners were assessed. Methods and procedures : Subjects with a self-reported history of TBI ( n ?=?22) were compared to the non-TBI group ( n ?=?16) on various psychological measures. Main outcomes and results : The two groups were not significantly different on the variables of age, pre-morbid IQ, self-esteem and alcohol use. The TBI group scored more poorly than the non-TBI group on a measure of current IQ and two of the three measures of executive functioning. Conclusion : The presence of executive dysfunction has implications for the design of successful intervention programmes with this sub-group of batterers.
01/26/2006
07:42 AM
What about theory of mind after severe brain injury
Source: Brain Injury Volume: 20 Number: 1 Page: 83 -- 91
Background : Behavioural changes are often reported after a severe traumatic brain injury (TBI). These changes are usually a greater burden for relatives than physical or cognitive impairments. This study investigated social cognition in TBI patients using two theory of mind (TOM) tasks. Method : The performances of 17 patients with severe TBI and 17 matched controls were compared on two tasks designed to investigate understanding of other people's mental states: The 'Reading the Mind in the Eyes' test (RME) and the 'Character Intention Task' (CIT). TBI patients and controls were also given several executive function tasks.
01/26/2006
07:41 AM
Increased inattentional blindness in severe traumatic brain injury Evidence for reduced distractibility
Source: Brain Injury Volume: 20 Number: 1 Page: 51 -- 60
Primary objective : To examine the role of selective attention and visual perception in medicating inattentional blindness in a severe traumatic brain injured sample. Research design : Cross-sectional design with age and education matched control sample. Methods and procedures : Twenty participants with severe traumatic brain injury ( n ?=?10) and matched controls ( n ?=?10) completed a series of tests of focused attention (Stroop test), divided attention (Trail Making Test), visual perception (Visual Object and Space Perception Battery) and two tasks of inattentional blindness. Main outcomes and results : The group with severe TBI were significantly slower on the Stroop test and TMT and displayed significantly elevated Stroop interference and TMT ratio scores. On the inattentional blindness tasks, fewer TBI participants identified a distracting stimulus. Conclusion : The results indicate severe TBI is associated with deficits to focused and divided attention with the finding of a potentially more debilitating impairment arising from reduced distractibility following severe TBI.
01/26/2006
07:39 AM
Complex analysis of intracranial hypertension using approximate entropy
Critical Care Medicine. 34(1):87-95, January 2006.
To determine whether decomplexification of intracranial pressure dynamics occurs during periods of severe intracranial hypertension (intracranial pressure >25 mm Hg for >5 mins in the absence of external noxious stimuli) in pediatric patients with intracranial hypertension.
01/26/2006
07:37 AM
Thalamic nicotinic receptors implicated in disturbed consciousness in dementia with Lewy bodies
Neurobiology of Disease Volume 21, Issue 1 , January 2006, Pages 50-56
Disturbances of consciousness (DOC) are common in dementia with Lewy bodies (DLB). Following previous findings of preserved temporal cortical high-affinity nicotinic binding relating to DOC, we investigated this receptor in thalamus, an area of high nicotinic receptor concentration, implicated in consciousness. 5-[125I]-A-85380 binding, primarily reflecting the a4ß2 subtype, was compared in 16 DLB patients with DOC and 6 without DOC, matched for duration and severity of dementia. Binding was higher in patients with DOC compared to patients without DOC in all thalamic nuclei examined, reaching significance in the reticular and ventral anterior thalamic nuclei. Comparing DLB patients with and without DOC to previously reported controls revealed similar binding levels in patients with DOC and lower binding in patients without DOC, reaching significance in the ventral anterior, indicating preserved nicotinic receptor density in DLB patients with DOC. These findings, together with previous neocortical data, implicate nicotinic modulation of thalamo-cortical circuitry as a key component in the control of conscious awareness in DLB.
01/26/2006
07:36 AM
Inhibition and object relations in borderline personality traits after traumatic brain injury
Source: Brain Injury Volume: 20 Number: 1 Page: 67 -- 81
This study aims to assess the nature and severity of borderline traits after traumatic brain injury (TBI). Thirty subjects with moderate or severe TBI were compared to 30 normal controls on the Revised Diagnostic Interview for Borderlines (DIB-R), a dimensional measure of borderline traits, the Go-no go inhibition task, the Complexity of Representations of People and Affect-Tone Relationships Paradigms, two scales from the Social Cognition and Object Relations Scale (SCORS) evaluating the quality of object relations, an estimation of pre-morbid borderline severity, the Beck Depression Inventory (BDI) and various neuropsychological measures.
01/26/2006
07:34 AM
Subarachnoid hemorrhage in survivors of out-of-hospital cardiac arrest true or not
The American Journal of Emergency Medicine Volume 24, Issue 1 , January 2006, Pages 123-125
Subarachnoid hemorrhage (SAH) presenting with out-of-hospital cardiac arrest (OHCA) and abnormal electrocardiographic (ECG) findings may be delay- or miss-diagnosed with the prevalence of training programs for advanced cardiovascular life support, which strengthen acute coronary syndromes (ACSs). Unfortunately, most managements for ACS might worsen SAH. Moreover, the diagnosis of SAH may affect the application of therapeutic hypothermia. We reported 2 OHCA survivors both with increased attenuation of the subarachnoid space on early cranial computed tomography (CT) scans after resuscitation and discussed the application of cranial CT scans in identifying possible OHCA causes and guiding further managements.
01/26/2006
07:33 AM
Lung protective ventilation in neurosurgical patients
Current Opinion in Critical Care. 12(1):3-7, February 2006.
Many patients with acute lung injury or acute respiratory distress syndrome and an acute brain injury may in fact be managed safely within the confines of a lung-protective strategy. Elevated levels of positive end-expiratory pressure in head-injured patients with acute lung injury or acute respiratory distress syndrome also appear to be safe, particularly when the level is set below that of the intracranial pressure, when patients have a low respiratory system compliance, or when positive end-expiratory pressure results in significant lung volume recruitment. Several novel therapies to minimize ventilator-induced lung injury are currently in the early stages of investigation in neurosurgical patients.
01/26/2006
07:31 AM
Acute lung injury in patients with subarachnoid hemorrhage Incidence risk factors and outcome
Critical Care Medicine. 34(1):196-202, January 2006
Objective: Pulmonary complications account for significant morbidity and mortality following aneurysmal subarachnoid hemorrhage; however, the effect of acute lung injury is largely unknown. The goal of this study was to determine the incidence of acute lung injury in a large cohort of patients with subarachnoid hemorrhage as well as determine the risk factors for acute lung injury and its effect on mortality and length of stay. Ventilator management was analyzed to determine the proportion of patients with subarachnoid hemorrhage and acute lung injury who a received a low-tidal volume ventilation strategy.
01/26/2006
07:29 AM
Bromocriptine in traumatic brain injury
Source: Brain Injury Volume: 20 Number: 1 Page: 111 -- 115
The authors report the case of a 63-year-old patient with severe traumatic brain injury (TBI) associated with Parkinson's syndrome, whose performances were dramatically improved by bromocriptine therapy, with an improvement of the scores, not only on tests evaluating motor functions but also on tests evaluating the patient's cognitive functions. However, no improvement was observed with levodopa.
01/26/2006
07:27 AM
Phase I Trial and Pharmacokinetic Study of the Farnesyltransferase Inhibitor Tipifarnib in Children With Refractory Solid Tumors or Neurofibromatosis Type I and Plexiform Neurofibromas
Journal of Clinical Oncology, Vol 24, No 3 (January 20), 2006: pp. 507-516
PURPOSE: This pediatric phase I trial of tipifarnib determined the maximum-tolerated dose
(MTD), pharmacokinetics, and pharmacodynamics of tipifarnib in children with refractory solid tumors and neurofibromatosis type 1 (NF1) –related plexiform
neurofibromas.
01/25/2006
02:40 PM
Outcome of a Comprehensive Neurorehabilitation Program for Patients With Traumatic Brain Injury
Archives of Physical Medicine and Rehabilitation Volume 86, Issue 12 , December 2005, Pages 2296-2302
We studied 19 consecutive adults with a significant TBI who underwent a comprehensive neurorehabilitation program and 20 control patients who received conventional rehabilitation referred by physicians in the general health care system. The outcome of the control patients was not known before the selection. The groups were similar in age, sex, education, injury severity (assessed on the Glasgow Coma Scale, radiologic and neuropsychologic findings, neurosurgical interventions), time from the injury, and preinjury employment status.
01/25/2006
02:39 PM
Management of Diabetes During Acute Stroke and Inpatient Stroke Rehabilitation
Archives of Physical Medicine and Rehabilitation Volume 86, Issue 12 , December 2005, Pages 2377-2384
To summarize evidence on the impact of hyperglycemia on stroke outcomes and to present therapy algorithms for inpatient management in diabetic stroke patients.
01/25/2006
02:38 PM
Motor learning its relevance to stroke recovery and neurorehabilitation
Current Opinion in Neurology. 19(1):84-90, February 2006.
Purpose of review: Much of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after injury a form of motor learning? (iv) Are approaches based on motor learning principles useful for rehabilitation?
01/25/2006
02:36 PM
Morphological and Cellular Aspects of the Aging Brain
Geriatrics and Aging Volume 9, Number 1, January 2006, Pages 44-48
Contemporary technologies, including digital imaging of the brain during life and quantative microscopy (unbiased stereology) for estimating histological features postmortem, have resulted in important new knowledge about changes in the brain that accompany healthy aging, including evidence that grey matter atrophies with an anterior-posterior gradient. Neurons shrink but numbers are preserved; however, there is moderate reduction in dendritic spines and in synapses that have altered function.
01/25/2006
02:35 PM
Fluent Conceptual Processing and Explicit Memory for Faces Are Electrophysiologically Distinct
The Journal of Neuroscience, January 18, 2006, 26
Implicit memory and explicit memory are fundamentally different manifestations of memory storage in the brain. Yet, conceptual fluency driven by previous experience could theoretically be responsible for both conceptual implicit memory and aspects of explicit memory. For example, contemplating the meaning of a word might serve to speed subsequent processing of that word and also make it seem familiar.
|
What
is RSS?
