The latest medical research on Neurology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about neurology gathered by our medical AI research bot.
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Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning: a resting-state fMRI study.Neuroradiology
To explore neuropathologic mechanisms in functional brain regions in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP) from the perspective of the brain network nodes by resting-state functional magnetic resonance imaging (rs-fMRI).
The fMRI and cognitive assessments were performed in 25 patients with DEACMP and 25 age-, sex- and education-matched healthy controls (HCs). Data analysis was performed via the degree centrality (DC) method. Then, the associations between the cognitive assessments and DC in the identified abnormal brain regions were assessed by using a correlation analysis.
Compared with the HCs, the DEACMP patients displayed significantly decreased DC values in the right superior frontal gyrus, right precentral gyrus, right angular gyrus, right marginal gyrus, right hippocampus, and left thalamus but increased DC values in the right inferior frontal gyrus, right cingulate gyrus, left superior temporal gyrus, left medial temporal gyrus, right lingual gyrus, and right posterior cerebellar lobe, pons, and midbrain (GRF correction, voxel P value < 0.001, cluster P value < 0.01). The correlation analysis in the DEACMP group revealed that there was a negative correlation between the DC values in the right hippocampus and MMSE scores, whereas a positive correlation was observed in the right cingulate gyrus.
Patients with DEACMP exhibited abnormal degree centrality in the brain network. This finding may provide a new approach for examining the neuropathologic mechanisms underlying DEACMP.
Correlation between diffusion tensor imaging measures and the reading and cognitive performance of Arabic readers: dyslexic children perspective.Neuroradiology
To investigate the correlation between the diffusion tensor imaging (DTI) measures and the reading, spelling, writing, rapid naming, memory, and motor abilities in Arabic dyslexic children. This could verify the influence of possible white matter alterations on the abilities of those children.
Twenty native Arabic-speaking children with dyslexia (15 males and 5 females; 8.2 years ± 1) underwent DTI of the brain on 1.5 T scanner. Diffusion-weighted images were acquired in 32 noncollinear direction. Tractography of the arcuate fasciculus (AF) was performed. Region of interest (ROI)-based approach was also used. Regions encompass superior longitudinal fasciculus (SLF), anterior and superior corona radiata (CR), and posterior limb of internal capsule (PLIC) were analyzed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured. The aptitudes of those children were evaluated by the dyslexia assessment test. These abilities were statistically correlated with the FA and ADC of the AF and other ROIs.
The reduction of FA of right AF was related to worse overall reading and related abilities performance. The ADC of right SLF was negatively correlated with memory abilities. The ADC of right PLIC was positively correlated with writing performance. Other relations were also found.
White matter microstructural DTI measurements in the right AF, right PLIC, SLF, and left anterior and superior CR are correlated to reading, spelling, writing, memory, and rapid naming abilities of the participants. The DTI measures could be promising regarding their use as a biomarker for follow-up in developmental dyslexia.
High frequency of ophthalmic origin of the middle meningeal artery in chronic subdural hematoma.Neuroradiology
Embolization of middle meningeal artery (MMA) has been proposed for postoperative recurrences and primary treatment of chronic subdural hematoma (CSDH). This endovascular intervention is safe only when MMA originates from the internal maxillary artery. The aim of this study was to report an unusual high frequency of MMA originating from the ophthalmic artery, which prohibits this treatment.
In this retrospective study, we reviewed the anatomical origin of the MMA in patients with CSDH who were referred to our center for endovascular treatment between January 2017 and May 2019 (42 patients with 58 CSDH). We compared the prevalence of this variant in a control group of 66 patients who underwent embolization for epistaxis during the same period.
In CSDH group, MMA originated from the ophthalmic artery in 8 out of 58 internal carotid arteries (13.8%). In the control group, this variant was observed in only 1 case out of 131 internal carotid arteries (0.7%) (OR = 20; 95% CI 2.6 to 925.2, p = 0.0003).
In this study, we report an extremely high prevalence of MMA originating from the ophthalmic artery in CSDH. In the hypothesis of prospective studies, a priori recognition of this variant will be necessary in order to exclude patients in whom endovascular treatment will not be feasible.
Imaging features of vertebral artery fenestration.Neuroradiology
Vertebral artery fenestration (VAF) is a rare congenital vascular anomaly which has been associated with intracranial aneurysm. VAF can share some similar imaging features with vertebral artery dissection (VAD), which may confound diagnosis of the latter on CT and MR angiography. The purpose of this investigation is to assess the prevalence of VAF, evaluate its association with other vascular anomalies, and identify imaging features to help in distinguishing VAF and VAD.
Using keyword search on CTA and MRA head and neck imaging reports from 2010 to 2017, cases of VAF and VAD were retrospectively identified and imaging was reviewed. Imaging features including laterality; vertebral segment; length of affected segment; presence, number, and caliber of lumen(s); and presence of other vascular abnormalities were recorded for all cases and subsequently compared using Pearson's chi-squared test to assess for significant differences between the groups. Patient age, gender, and clinical presentations were also recorded.
Of 64,888 CT and MR angiographic examinations performed, VAF was identified in 67 (0.1%) and VAD in 54 (0.1%) patients. Compared with VADs, VAFs were shorter in length (p < 0.001), wider in luminal diameter (p < 0.001), more likely to occur at the V4 segment (p < 0.01), more likely to have two distinct lumens rather than one (p < 0.01), and less likely to present post-trauma (p < 0.01). Coexisting intracranial aneurysms were identified in 9% of patients with VAF.
VAFs, although rare, can be readily distinguished from VADs on angiographic imaging. Diagnosis of VAF should prompt review for intracranial aneurysm.
Health comorbidities and cognitive abilities across the lifespan in Down syndrome.Journal of Neurodevelopmental Disorders
Down syndrome (DS) is associated with variable intellectual disability and multiple health and psychiatric comorbidities. The impact of such comorbidities on cognitive outcomes is unknown. We aimed to describe patterns of physical health and psychiatric comorbidity prevalence, and receptive language ability, in DS across the lifespan, and determine relationships with cognitive outcomes.
Detailed medical histories were collected and cognitive abilities measured using standardised tests for 602 individuals with DS from England and Wales (age range 3 months to 73 years). Differences in prevalence rates between age groups and between males and females were determined using chi-squared or Fisher's exact tests. In adults, rates for psychiatric comorbidities were compared to expected population rates using standardised morbidity ratios (SMRs). Adapted ANCOVA functions were constructed to explore age and sex associations with receptive language ability across the lifespan, and regression analyses were performed to determine whether the presence of health comorbidities or physical phenotypes predicted cognitive abilities.
Multiple comorbidities showed prevalence differences across the lifespan, though there were few sex differences. In adults, SMRs were increased in males and decreased in females with DS for schizophrenia, bipolar disorder, and anxiety. Further, SMRs were increased in both males and females with DS for dementia, autism, ADHD, and depression, with differences more pronounced in females for dementia and autism, and in males for depression. Across the lifespan, receptive language abilities increasingly deviated from age-typical levels, and males scored poorer than females. Only autism and epilepsy were associated with poorer cognitive ability in those aged 16-35 years, with no relationships for physical health comorbidities, including congenital heart defects.
Our results indicate the prevalence of multiple comorbidities varies across the lifespan in DS, and in adults, rates for psychiatric comorbidities show different patterns for males and females relative to expected population rates. Further, most health comorbidities are not associated with poorer cognitive outcomes in DS, apart from autism and epilepsy. It is essential for clinicians to consider such differences to provide appropriate care and treatment for those with DS and to provide prognostic information relating to cognitive outcomes in those with comorbidities.
Fat fraction distribution in lower limb muscles of patients with CMT1A: A quantitative MRI study.Neurology
To quantitatively describe the MRI fat infiltration pattern of muscle degeneration in Charcot-Marie-Tooth (CMT) type 1A (CMT1A) disease and to look for correlations with clinical variables.
MRI fat fraction was assessed in lower-limb musculature of patients with CMT1A and healthy controls. More particularly, 14 muscle compartments were selected at leg and thigh levels and for proximal, distal, and medial slices. Muscle fat infiltration profile was determined quantitatively in each muscle compartment and along the entire volume of acquisition to determine a length-dependent gradient of fat infiltration. Clinical impairment was evaluated with muscle strength measurements and CMT Examination Scores (CMTESs).
A total of 16 patients with CMT1A were enrolled and compared to 11 healthy controls. Patients with CMT1A showed a larger muscle fat fraction at leg and thigh levels with a proximal-to-distal gradient. At the leg level, the largest fat infiltration was quantified in the anterior and lateral compartments. CMTES was correlated with fat fraction, especially in the anterior compartment of leg muscles. Strength of plantar flexion was also correlated with fat fraction of the posterior compartments of leg muscles.
On the basis of quantitative MRI measurements combined with a dedicated segmentation method, muscle fat infiltration quantified in patients with CMT1A disclosed a length-dependent peroneal-type pattern of fat infiltration and was correlated to main clinical variables. Quantification of fat fraction at different levels of the leg anterior compartment might be of interest in future clinical trials.
Prehospital selection of thrombectomy candidates beyond large vessel occlusion: M-DIRECT scale.Neurology
Current prehospital scales used to detect large vessel occlusion reveal very low endovascular thrombectomy (EVT) rates among selected patients. We developed a novel prehospital scale, the Madrid-Direct Referral to Endovascular Center (M-DIRECT), to identify EVT candidates for direct transfer to EVT-capable centers (EVT-Cs). The scale evaluated clinical examination, systolic blood pressure, and age. Since March 2017, patients closer to a stroke unit without EVT capabilities and an M-DIRECT positive score have been transferred to the nearest EVT-C. To test the performance of the scale-based routing protocol, we compared its outcomes with those of a simultaneous cohort of patients directly transferred to an EVT-C.
In this prospective observational study of consecutive patients with stroke code seen by emergency medical services, we compared diagnoses, treatments, and outcomes of patients who were closer to an EVT-C (mothership cohort) with those transferred according to the M-DIRECT score (M-DIRECT cohort).
The M-DIRECT cohort included 327 patients and the mothership cohort 214 patients. In the M-DIRECT cohort, 227 patients were negative and 100 were positive. Twenty-four (10.6%) patients required secondary transfer, leaving 124 (38%) patients from the M-DIRECT cohort admitted to an EVT-C. EVT rates were similar for patients with ischemic stroke in both cohorts (30.9% vs 31.5%). The M-DIRECT scale had 79% sensitivity, 82% specificity, and 53% positive predictive value for EVT. Recanalization and independence rates at 3 months did not differ between the cohorts.
The M-DIRECT scale was highly accurate for EVT, with treatment rates and outcomes similar to those of a mothership paradigm, thereby avoiding EVT-C overload with a low rate of secondary transfers.
Pathologic tearfulness after limbic encephalitis: A novel disorder and its neural basis.Neurology
We investigated the nature and neural foundations of pathologic tearfulness in a uniquely large cohort of patients who had presented with autoimmune limbic encephalitis (aLE).
We recruited 38 patients (26 men, 12 women; median age 63.06 years; interquartile range [IQR] 16.06 years) in the postacute phase of aLE who completed questionnaires probing emotion regulation. All patients underwent structural/functional MRI postacutely, along with 67 age- and sex-matched healthy controls (40 men, 27 women; median age 64.70 years; IQR 19.87 years). We investigated correlations of questionnaire scores with demographic, clinical, neuropsychological, and brain imaging data across patients. We also compared patients diagnosed with pathologic tearfulness and those without, along with healthy controls, on gray matter volume, resting-state functional connectivity, and activity.
Pathologic tearfulness was reported by 50% of the patients, while no patient reported pathologic laughing. It was not associated with depression, impulsiveness, memory impairment, executive dysfunction in the postacute phase, or amygdalar abnormalities in the acute phase. It correlated with changes in specific emotional brain networks: volume reduction in the right anterior hippocampus, left fusiform gyrus, and cerebellum, abnormal hippocampal resting-state functional connectivity with the posteromedial cortex and right middle frontal gyrus, and abnormal hemodynamic activity in the left fusiform gyrus, right inferior parietal lobule, and ventral pons.
Pathologic tearfulness is common following aLE, is not a manifestation of other neuropsychiatric features, and reflects abnormalities in networks of emotion regulation beyond the acute hippocampal focus. The condition, which may also be present in other neurologic disorders, provides novel insights into the neural basis of affective control and its dysfunction in disease.
An update on the CNS manifestations of brain tumor polyposis syndromes.Acta Neuorpathica
Cancer predisposition syndromes are associated with an increased risk of developing primary malignancies. Here we discuss those which are associate...
Assessing participation of children with acquired brain injury and cerebral palsy: a systematic review of measurement properties.Cerebral Palsy
To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection.
Five databases were searched. Instruments that quantified 'attendance' and/or 'involvement' aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed.
Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations.
Twelve instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) aligned with attendance/involvement. Seven instruments have some psychometric evidence supporting their use with children with CP. For children with ABI, only the Child and Adolescent Scale of Participation has shown preliminary evidence of measurement properties.
Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts."Movement Disorders Clinical Practice
Exercise is gaining extreme relevancy as a new therapeutic intervention for Parkinson's disease (PD). However, the frequent misuse of the concepts exercise, physiotherapy, and physical activity limits the possibility of summarizing research findings. This review aims to clarify these concepts and summarize the evidence on exercise in PD.
We critically appraised physical activity-related concepts and conducted a systematic review of clinical trials evaluating exercise interventions in PD. Additionally, we discussed the implications for PD clinical practice and research.
Exercise is a subset of physical activity, and a major component of physiotherapy for PD management, having as the main goal to improve physical fitness. The appraisal of the 83 identified clinical trials found high variability in exercise interventions. Multimodal exercise was the most studied, and 60 minutes, two times/week for 12 weeks, the most reported prescription parameters.
The best available evidence recommends increasing physical activity levels in PD. Exercise and physiotherapy programs seem the most efficacious strategies to achieve this goal. As a result of the heterogeneity in the type and manner exercise is prescribed, it is not possible to propose strong recommendations for exercise in PD. We believe that, in addition to the clarification of concepts here presented, a collaborative and rigorous work of different areas of knowledge is needed.
Falls in Progressive Supranuclear Palsy."Movement Disorders Clinical Practice
Despite falls being an almost universal clinical feature and central to the presentation and diagnostic criteria of progressive supranuclear palsy, our understanding of falls is surprisingly limited and there are few effective treatment options.
To provide an overview of the topic of the impact, assessment, mechanism, and management of falls in progressive supranuclear palsy.
We performed a literature search for "falls" and "progressive supranuclear palsy" and included additional relevant literature known to us. We synthesized this literature with experience from clinical practice.
We review current understanding of the pathophysiology of falls, highlighting the roles of the indirect pathway and the pedunculopontine nucleus. We go on to identify shortcomings in commonly used assessments to measure falls. We discuss medical and nonmedical fall prevention strategies, and finally we discuss balancing falls risk against promoting independence.
Falls are central to progressive supranuclear palsy presentation and diagnosis. Indirect locomotor and pedunculopontine nucleus dysfunction are thought to be the neural substrate of falls in this condition. Attempts to measure and prevent falls, by medical and nonmedical means, are currently limited. A personalized approach is advocated in the management of falls.