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Journal of Head Trauma Rehabilitation. Focus on Clinical Research and Practice, Part 2. 21(3):272-278, May/June 2006
To determine whether diffusion tensor imaging (DTI) can detect diffuse axonal injury, and to evaluate the association of DTI findings with motor function in patients with traumatic brain injury.
International Journal of Rehabilitation Research. 29(2):105-111, June 2006
The objectives of this study were to examine the demographic and clinical characteristics of stroke patients admitted for inpatient rehabilitation, to study the occurrence of medical problems/complications, and to document functional outcome and possible factors influencing outcome.
International Journal of Rehabilitation Research. 29(2):123-129, June 2006
The educational group has been proposed as an effective way to deliver a program based on structured stroke knowledge to enhance emotional support among people with stroke and their caregivers. The aim of this study was to explore whether the stroke educational group could increase stroke-related knowledge, and improve perceived health status, in persons with stroke and their caregivers, and thus reduce the stress induced during the care-giving process.
International Journal of Rehabilitation Research. 29(2):137-143, June 2006
The aim of this study was to examine the predictive factors, and their relative strengths, for predicting length of rehabilitation stay using the path model. One hundred and seventeen stroke patients were recruited from two rehabilitation units in university-affiliated hospitals in northern Taiwan. The Taiwanese Rehabilitation Database System was used to collect the patient's relevant information. Path analysis was used to explore the relative strengths of each predictive factor. The results showed that the ability to engage in self-care activities was the only direct predictor, whereas subjective well-being and cognitive social skills had an indirect effect on the length of rehabilitation stay, mediating through cognitive-social skills and ability to engage in activities of daily living, respectively.
The Journal of Neuroscience, July 12, 2006, 26(28):7532-7540
Modulating the behaviors of reactive astrocytes is a potential therapeutic strategy for neurodegenerative diseases. We found that upregulation and activation of the epidermal growth factor receptor (EGFR) occur in astrocytes after different injuries in optic nerves in vivo. Activation of EGFR regulates genes and cellular processes representing most major markers of reactive astrocytes and genes related with glaucomatous optic neuropathy and other neural disorders. These results suggest that activation of EGFR is a common, regulatory pathway that triggers quiescent astrocytes into reactive astrocytes in response to neural injuries in the optic nerve, and perhaps other parts of the CNS.
The Journal of Neuroscience, July 12, 2006, 26(28):7380-7389
Embryonic medial ganglionic eminence (MGE) cells transplanted into the adult brain can disperse, migrate, and differentiate to neurons expressing GABA, the primary inhibitory neurotransmitter. It has been hypothesized that grafted MGE precursors could have important therapeutic applications increasing local inhibition, but there is no evidence that MGE cells can modify neural circuits when grafted into the postnatal brain. Here we demonstrate that MGE cells grafted into one location of the neonatal rodent brain migrate widely into cortex.
Archives of Disease in Childhood - Fetal and Neonatal Edition 2006;91:F204-F207
Neonatal stroke may occur silently. Identification of potential embolic pathways unique to the neonate is important when investigating the aetiology of infarction and arterial occlusion, and preventing further episodes. This is a case report of an infant with venous thrombus embolising across the foramen ovale causing cerebral infarction and subclavian artery steal syndrome, without neurological signs.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 16(2):94-98, April 2006
A 78-year-old man underwent biliary stenting by means of endoscopy for obstructive jaundice due to common bile duct cancer. Despite uneventful operation, the patient remained comatose and began to hiccup and vomit with marked gastrointestinal gas retention. Neuroimaging studies disclosed obstructive hydrocephalus caused by a midbrain metastasis, probably from coexisting lung cancer. Ventricular peritoneal shunting restored consciousness and eliminated other gastrointestinal symptoms. This case suggests that gastrointestinal endoscopy may affect concurrent intracranial lesions, resulting in acute distress, presumably by transmission of pressure from the abdomen to a distant body compartment such as the intracranial space, or by endoscopy-related hypoventilation.
Journal of Trauma-Injury Infection & Critical Care. 61(1):226-233, July 2006
Repeat head computed tomography (CT) is standard practice for head-injured patients at many trauma centers. Utilization of CT has increased over time, yet effects on outcome and associated risks are unknown. We systematically reviewed the literature to determine the incidence of progression of injury on repeat CT and resulting treatment changes.
The authors performed hippocampal volumetry and T2 relaxometry in 84 consecutive patients with partial epilepsy from a protocol for antiepileptic drug (AED) withdrawal after at least 2 years of seizure control. Seizure recurrence after AED withdrawal was more frequent among patients with hippocampal atrophy and abnormal hippocampal T2 signal.
Call–Fleming syndrome is a reversible segmental vasoconstriction of cerebral arteries manifested by a "thunderclap" headache and focal neurologic symptoms. Although of unknown etiology, it has been reported in association with vasoactive sympathomimetic drugs. The authors report Call–Fleming syndrome in two patients with history of antidepressant use. Although the association is hypothetical, the authors suggest consideration of Call–Fleming syndrome in patients presenting with headache, focal deficits, and evidence of cerebral ischemia during antidepressant use.
Calcium (Ca2+) and magnesium (Mg2+) influence the molecular pathways of ischemic neuronal death. The authors evaluated the impact of admission serum Ca2+ and Mg2+ levels, on incident stroke severity and discharge functional outcome. After adjusting for covariates, higher admission Ca2+ was significantly associated with lesser stroke severity and better discharge functional outcome. Admission Mg2+ was not an independent clinical outcome prognosticator.
To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke.
Journal of Trauma-Injury Infection & Critical Care. 61(1):107-110, July 2006
A large population of patients on oral anticoagulants is exposed to the risk of traumatic brain injury (TBI). Effects of age and anticoagulation on TBI outcomes need to be assessed separately.
Surgical Practice, Volume 10, Number 3, August 2006, pp. 106-110(5)
Preoperative devascularization of intracranial meningioma by endovascular embolization has been performed in many institutes over the past 30?years. Advancement in microsurgical techniques and endovascular technology during the period may have offset or magnified the benefit of the procedure. The aim of the present study was to evaluate the effect of preoperative embolization on surgical resection of intracranial meningiomas.
Although the functions of sleep remain largely unknown, one of the most exciting hypotheses is that sleep contributes importantly to processes of memory and brain plasticity. Over the past decade, a large body of work, spanning most of the neurosciences, has provided a substantive body of evidence supporting this role of sleep in what is becoming known as sleep-dependent memory processing. We review these findings, focusing specifically on the role of sleep in (a) memory encoding, (b) memory consolidation, (c) brain plasticity, and (d) memory reconsolidation; we finish with a summary of the field and its potential future directions.
Epileptic Disorders. Volume 8, Number 1, 44-54, April 2006
Neurodegenerative disorders in adults are progressively recognized as one of the major causes of epilepsy. Improved health care, resulting in increased longevity, will unavoidably lead to an increase of epilepsy cases in the elderly. For example, in Alzheimer’s disease, almost 10% of the patients present with seizures, eventually necessitating an antiepileptic treatment. We review available data on epidemiology, diagnosis and treatment of the epilepsies when associated with major neurodegenerative disorders. Controlled, prospective studies are lacking.
Epileptic Disorders. Volume 8, Number 1, 37-43, April 2006
The progressive myoclonus epilepsies (PME) are rare diseases and many clinicians, who have only few opportunities to encounter such patients, may think of them as mythical.
Epileptic Disorders. Volume 8, Number 1, 69-71, April 2006
Stroke is a major cause of seizures in the elderly. About 10% of all stroke patients experience one or several seizures\; they may occur during the first 24 hours after the stroke, in the early and late stages and after several months or even years following the initial vascular accident. We review current data on epidemiology, risk factors, semiology, differential diagnosis, follow-up and recurrence, and management of seizures following stroke.
Journal of Stroke and Cerebrovascular Diseases Volume 15, Issue 4 , 8 July 2006, Pages 144-150
The Broderick system and the intracerebral hemorrhage (ICH) score are two systems for predicting 30-day mortality in patients with spontaneous ICH. No previous study has compared two ICH scoring systems in an independent patient cohort. Our purpose was to externally validate and directly compare these two systems and evaluate the effect of withdrawal of care on system performance.
Journal of Stroke and Cerebrovascular Diseases Volume 15, Issue 4 , 8 July 2006, Pages 139-143
Early supported discharge (ESD) with continued rehabilitation at home has shown a beneficial effect on extended activities of daily living 5 years after stroke. The long-term effect of ESD on resource use has not been explored.
Journal of Stroke and Cerebrovascular Diseases Volume 15, Issue 4 , 8 July 2006, Pages 172-175
Dysphagia is a common symptom in acute stroke. However, stroke-related dysphagia usually improves faster than other neurologic symptoms. Therefore, in addition to early diagnosis of dysphagia, closely meshed monitoring is necessary to guide appropriate protective and nutritional strategies. We propose serial fiber-optic endoscopic evaluation of swallowing as a valuable tool for this purpose. The clinical impact of serial fiberoptic endoscopic evaluation of swallowing is exemplified by reporting on a patient with a complicated course of stroke-related dysphagia.
Journal of Stroke and Cerebrovascular Diseases Volume 15, Issue 4 , 8 July 2006, Pages 151-157
Patients with mild stroke are assumed to achieve full recovery with little or no intervention. However, recent studies suggest that such patients may experience persistent disability and difficulty with complex activities.
Journal of Stroke and Cerebrovascular Diseases Volume 15, Issue 4 , 8 July 2006, Pages 164-171
Dysphagia and poor nutritional status occur frequently after stroke; however, potential associations between them are unknown. We evaluated potential associations between dysphagia and poor nutritional status in patients with acute ischemic stroke. Potential associations between these outcomes and more global stroke severity measures were also assessed.
The Journal of Neuroscience, July 5, 2006, 26(27):7234-7244
Understanding the transcriptional response to neuronal injury after trauma is a necessary prelude to formulation of therapeutic strategies. We used Serial Analysis of Gene Expression (SAGE) to identify 50,000 sequence tags representing 18,000 expressed genes in the cortex 2 h after traumatic brain injury (TBI). A similar tag library was obtained from sham-operated cortex. The SAGE data were validated on biological replicates using quantitative real-time-PCR on multiple samples at 2, 6, 12, and 24 h after TBI.
Journal of Head Trauma Rehabilitation. Focus on Clinical Research and Practice, Part 2. 21(3):226-235, May/June 2006
To examine the relation between impaired awareness of deficits (IAD) and treatment adherence and to verify previous findings regarding the types of disabilities that people with traumatic brain injury (TBI) tend to underestimate.
Healthy lifestyle has been associated with decreased risk of coronary heart disease. In contrast, little is known about its association with stroke risk.
Calcium (Ca2+) and magnesium (Mg2+) influence the molecular pathways of ischemic neuronal death. The authors evaluated the impact of admission serum Ca2+ and Mg2+ levels, on incident stroke severity and discharge functional outcome. After adjusting for covariates, higher admission Ca2+ was significantly associated with lesser stroke severity and better discharge functional outcome. Admission Mg2+ was not an independent clinical outcome prognosticator.
Malignant gliomas are frequently characterized by amplification of the epidermal growth factor receptor (EGFR) and loss of PTEN tumor suppressor gene. Twenty-eight heavily pretreated patients with recurrent malignant gliomas were administered EGFR inhibitors (gefitinib or erlotinib) in combination with the mTOR (mammalian target of rapamycin) inhibitor sirolimus. The regimens were reasonably well tolerated. Nineteen percent of patients experienced a partial response and 50% had stable disease. Six-month progression-free survival for glioblastoma patients was 25%.
To investigate the diagnostic value of transforming growth factor ß1 (TGFß1), vascular endothelial growth factor (VEGF), urokinase-type plasminogen activator (uPA), and tissue-type plasminogen activator (tPA) in CSF for leptomeningeal metastasis (LM).
To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke.
To determine whether relative cerebral blood volume (rCBV) can predict patient outcome, specifically tumor progression, in low-grade gliomas (LGGs) and thus provide a second reference standard in the surgical and postsurgical management of LGGs.
Recovery of posterior communicating artery aneurysm-induced oculomotor nerve palsy (ONP) after aneurysm coiling has been reported. However, the coil mass may compromise recovery of the nerve. Therefore, we compared the outcome of coiling and clipping for this indication.
Clinical and experimental evidence suggests that hyperglycemia lowers the neuronal ischemic threshold, potentiates stroke volume in focal ischemia, and is associated with morbidity and mortality in the surgical critical care setting. It remains unknown whether hyperglycemia during carotid endarterectomy (CEA) predisposes patients to perioperative stroke and operative related morbidity and mortality.
The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 7 2569-2573
Thyroid function has been related to Alzheimer disease (AD), but it remains unclear whether thyroid dysfunction results from or contributes to developing AD.
To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia.
Journal of Cognitive Neuroscience. 2006;18:1212-1222
Executive function mediated by prefrontally driven distributed networks is frequently impaired by traumatic brain injury (TBI) as a result of diffuse axonal injury and focal lesions. In addition to executive cognitive functions such as planning and working memory, the effects of TBI impact social cognition and motivation processes. To encourage application of cognitive neuroscience methods to studying recovery from TBI, associated reorganization of function, and development of interventions, this article reviews the pathophysiology of TBI, critiques currently employed methods of assessing executive function, and evaluates promising interventions that reflect advances in cognitive neuroscience. Brain imaging to identify neural mechanisms mediating executive dysfunction and response to interventions following TBI is also discussed.
Journal of Cognitive Neuroscience. 2006;18:1223-1236
The spatial neglect syndrome, defined by asymmetric attention and action not attributed to primary motor or sensory dysfunction and accompanied by functional disability, is a major cause of post-stroke morbidity. In this review, we consider the challenges and obstacles facing scientific researches wishing to evaluate the mechanisms and effectiveness of rehabilitation interventions. Spatial neglect is a heterogeneous disorder, for which consensus research definitions are not currently available, and it is unclear which of the deficits associated with the syndrome causes subsequent disability. We review current opinion about methods of assessment, suggest a rational approach to selecting therapies which requires further study, and make systems-level and theoretical recommendations for building theory. We lastly review some creative questions for consideration in future research.
Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 4, 2006 321-330
Enteral nutrition support has been commonly used to improve nutrition status in acute stroke patients. The purpose of this study was to examine whether significant alterations in fluid and serum Na+ and K+ levels due to nasogastric tube feeding depended on patient age.
Prehospital Emergency Care, Volume 10, Number 3, July-September 2006, pp. 369-373(5)
Only 31%-52% of stroke calls are accurately identified by 9-1-1 dispatchers according to prior studies. Recognizing the time-dependent nature of acute stroke, better identification of stroke patients at the time of their 9-1-1 calls may allow an improved prehospital response. We sought to identify any words/phrases that 9-1-1 dispatchers could use to identify more stroke calls.
To describe variations in the presentation of monocular visual loss associated with intracranial aneurysm rupture. The clinical course, possible etiologies and management of visual loss in three patients are described.
The present study investigated the prevalence of cognitive deficits in acute lacunar stroke, validated the Mini Mental State Examination (MMSE) in detecting cognitive impairments in lacunar patients, and identified predictors of such deficits.
EEG is the only available method for real time monitoring of the brain and is therefore of great interest in the neurointensive care. The present study describes our experiences from implying continuous EEG monitoring as a routine method. We also present EEG patterns observed on patients with traumatic brain injury (TBI).
Swedish snuff is a particular form of non-smoking tobacco with high nicotine content. It is unknown whether this form of tobacco is a risk factor similar to smoking for suffering subarachnoid haemorrhage (SAH). In the present study we report our finding concerning smoking and snuff as risk factors for the disease.
Strokes represent the most common etiology of epilepsy in patients over the age of 60?years, with an incidence of 2-4% occurring in different studies. In this observational study, 1,428 patients were included who had stroke and were admitted to our Stroke Unit between the years 1996 and 2005.
Valproate-induced hyperammonemic encephalopathy (VHE) is an unusual complication characterized by a decreasing level of consciousness, focal neurological deficits, cognitive slowing, vomiting, drowsiness, and lethargy. We have thoroughly reviewed the predisposing factors and their screening, the biochemical and physiopathological mechanisms involved, the different treatments described, and those that are being investigated. Etiopathogenesis is not completely understood, although hyperammonemia has been postulated as the main cause of the clinical syndrome.
How the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF.
Crouzon syndrome is caused by mutations in fibroblast growth factor receptor 2 (FGFR2) leading to constitutive activation of receptors in the absence of ligand binding. The syndrome is characterized by premature fusion of the cranial sutures that leads to abnormal cranium shape, restricted brain growth, and increased intracranial pressure. Surgical remodeling of the cranial vault is currently used to treat affected infants. The purpose of this study was to develop a pharmacological strategy using tyrosine kinase inhibition as a novel treatment for craniosynostotic syndromes caused by constitutive FGFR activation.
The majority of tumors of the cerebellopontine angle (CPA) are benign. We report the case of a primary malignant melanoma of the CPA that mimicked a vestibular schwannoma (acoustic neuroma). We discuss the differential diagnosis and prognosis of melanotic lesions at this location.
Spontaneous intracranial hypotension is a potentially severe condition characterized by a distinct clinical picture caused by low cerebrospinal fluid pressure. Although coma has been reported previously as a presentation of this condition, this is the first report in which misdiagnosis of this condition and unwarranted surgery led to coma.
After excision of an arteriovenous malformation (AVM), intracerebral hemorrhage or edema can develop, most probably resulting from hyperperfusion. Changes in the perinidal cerebral microvessels probably play a role in the development of this complication but have not been well studied so far. In this study, microvascular changes associated with resection of an AVM were observed and quantified intraoperatively using orthogonal polarization spectral imaging.
Balance deficits in individuals experiencing mild traumatic brain injury have been documented in numerous recent studies. However, long-lasting balance deficits and specific mechanisms causing these deficits have not been systematically examined. This article aimed to present empirical evidence showing destabilizing effects of visual field motion in concussed individuals up to 30 days postinjury.
To evaluate incidence and risk factors of postoperative meningitis, with special emphasis on antibiotic prophylaxis, in a series of 6243 consecutive craniotomies.
Intraoperative localization of speech is problematic in patients who are fluent in different languages. Previous studies have generated various results depending on the series of patients studied, the type of language, and the sensitivity of the tasks applied. It is not clear whether languages are mediated by multiple and separate cortical areas or shared by common areas. Globally considered, previous studies recommended performing a multiple intraoperative mapping for all the languages in which the patient is fluent. The aim of this work was to study the feasibility of performing an intraoperative multiple language mapping in a group of multilingual patients with a glioma undergoing awake craniotomy for tumor removal and to describe the intraoperative cortical and subcortical findings in the area of craniotomy, with the final goal to maximally preserve patients' functional language.
To determine treatment outcome after surgical resection for progressive brain metastases after gamma knife radiosurgery (GKR) and to explore the role of dynamic contrast agent-enhanced perfusion magnetic resonance imaging (MRI) and proton spectroscopic MRI studies (MRS/P) in predicting pathological findings.
To study risk factors for the development of postoperative neurological deficits after brain tumor resection and to define prognostic factors for recovery.
To stratify the risk of embolization during the treatment of cerebral arteriovenous malformations (AVMs) by grade and to assess its impact on the overall treatment risk.
Stroke is a leading cause of morbidity and mortality in the United States. Recent animal studies have implicated the complement system in cerebral ischemia/reperfusion injury and suggest that complement inhibition may improve stroke outcomes. To assess the applicability of these findings to humans, we evaluated the characteristics and time course of human complement activation after stroke.
We developed a modification of the Fisher computed tomographic rating scale and compared it with the original Fisher scale to determine which scale best predicts symptomatic vasospasm after subarachnoid hemorrhage.
To investigate risk factors, such as heavy alcohol consumption, that might explain any increased risk of haemorrhagic stroke associated with low blood cholesterol.
Medicine & Science in Sports & Exercise. 38(6):1041-1046, June 2006
Locomotor impairment, such as that which may occur following a stroke, results in increased energy expenditure during walking. Previous research quantifying this increased metabolic demand has focused on older people; thus, the aim of this study was to investigate the physiological cost of walking in younger patients following stroke.
The EEG activity of the thalamus and temporal lobe structures (hippocampus, entorhinal cortex and neocortex) was obtained using intracerebral recordings (stereoelectroencephalography, SEEG) performed in patients with TLE seizures undergoing pre-surgical evaluation. Synchrony was studied using a statistical measure of SEEG signal interdependencies (non-linear correlation).
This study assessed gender differences in diabetic patients with ischemic stroke with respect to vascular risk factors, clinical features and early outcome. Ischemic stroke was diagnosed in 261 diabetic women and 300 diabetic men of 2,446 ischemic stroke patients included in a prospective stroke registry over 17 years.
Brain Injury Volume 20, Number 7 / June 2006 679 - 685
Subarachnoid haemorrhage (SAH) remains an important cause of stroke in the rehabilitation population, whose incidence has not been changed by pre-morbid medical treatment. The understanding of the pathophysiological changes that occur after SAH has been more clearly defined, therefore the treatment and outcomes of these patients have undergone drastic changes over the past few years.
Brain Injury Volume 20, Number 7 / June 2006 687 - 693
The subject of Inappropriate Sexual Behaviour (ISB) amongst clients with neurological impairment, specifically Acquired Brain Injury (ABI) and dementia, has received limited coverage to date within the literature. This paper discusses some of the problems encountered in the definition and quantification of ISB, in particular the absence of standardized measurement tools to record ISB within an inpatient setting. Whilst ISB is reported to be less prevalent than other behavioural sequelae of brain injury or dementia, it is suggested that its impact on patients and carers can be significant. Ill-defined terminology and the absence of relevant assessment tools add to the specific challenges of understanding and managing ISB within a care or rehabilitation setting. As a result, it is argued that the subjective attitudes of staff and the culture of an institution can dominate the approach taken to dealing with ISB for these client groups.
Brain Injury Volume 20, Number 7 / June 2006 695 - 699
To examine post-traumatic amnesia (PTA) and its relation to long-term cerebral atrophy in persons with traumatic brain injury (TBI) using objective indicators of PTA duration and Quantitative Magnetic Resonance Imaging (QMRI). It was hypothesized that longer PTA would predict later generalized atrophy (increased ventricle-to-brain ratio (VBR)). As a guide in assessing patients with TBI, this study determined the probability of developing chronic cerebral atrophy based on PTA duration.
Brain Injury Volume 20, Number 7 / June 2006 711 - 718
This paper presents research results regarding disclosure of traumatic brain injury (TBI) diagnosis and resulting deficits of a study aiming to investigate the experiences of individuals who had sustained a TBI, their families, the physicians and health professionals involved, from the critical care episodes and subsequent rehabilitation.
Brain Injury Volume 20, Number 7 / June 2006 719 - 724
Traumatic brain injury (TBI) at the workplace is a significant contributor to the number of work-related deaths that occur per year. This study aimed to quantify and characterize these deaths in Ontario.
Brain Injury Volume 20, Number 7 / June 2006 725 - 732
To investigate differences between a group with mild traumatic brain injury (MTBI) and a control group relative to standard scores and error type during word retrieval in both naming and discourse tasks.
Brain Injury Volume 20, Number 7 / June 2006 733 - 742
(1) To examine survivors with traumatic brain injury (TBI) for symptoms of avoidance and intrusion, two dimensions of post-traumatic stress (PTS) at 6 and 12 months post-injury. (2) To identify risk factors associated with these symptoms.
Brain Injury Volume 20, Number 7 / June 2006 743 - 758
One of the most challenging tasks for clinicians caring for survivors of severe brain injury (BI) is establishing a prognosis, for long-term functional outcome, while the patient is unconscious. The objective of this article is to report findings regarding the prediction of functional outcomes 1-year after severe BI using data available when the patient is unconscious.
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