bluuebunny/crossref_metadata_2025 huggingface dataset:
P.009 Canadian Survey of the neurological care provided to women living with epilepsy: preliminary results
Authors: Fantaneanu T , Bui E
Published: June 2022

Background: In Canada, approximately 300,000 women with epilepsy (WWE) are of childbearing potential. Given the unique aspects of providing care for WWE, our objective was to gather demographic and practice characteristics of health care professionals providing care for WWE to identify potential gaps. Methods: We developed a questionnaire to understand the demographic and practice characteristics of professionals providing care for WWE. We invited all French and English practitioners (physicians, physician assistants and nurse practitioners), recruited through the Canadian League Against Epilepsy (CLAE), Canadian Neurological Sciences Federation (CNSF) and Canadian Epilepsy nursing Group (CENG), to complete our online questionnaire. Results: Preliminary data show 43% were between 32-40 years of age and 76% were medical doctors. Sixty-three percent had been in practice for less than 20 years; 81% considered themselves epilepsy specialists and 66% devoted their practice entirely to epilepsy patients and 78% practiced exclusively in academic centers. Conclusions: Our data shows providers involved in the care of women with epilepsy in Canada are predominantly academic experts in epilepsy. Potential gaps in care include mid-late career physicians, non-specialized health care practitioners, and community-based practices, as less likely to provide care for WWE. This snapshot may provide future insights to the unmet needs of WWE Canada.
P.014 Immunotherapy responses of patients with suspected autoimmune-associated epilepsy with negative neural antibody testing
Authors: ALKhaldi N , Budhram A , Burneo J , Mirsattari S , Jones M , Suller-Marti A
Published: June 2022

Background: In refractory epilepsy patients with possible autoimmune-associated epilepsy (AAE) but negative antibody testing(-AB), immunotherapy trials (IMT) may still be pursued.The value of (IMT) in such patients remains unclear. For this reason, we reviewed their immunotherapy responses. Methods: Retrospective review of epilepsy patients admitted to the Epilepsy Unit between (2018-2021) who received (IMT). All had (-AB) and received immunotherapy (methylprednisolone (IVMP)-immune globulin (IVIg)-plasma exchange (PLEX)- rituximab).We considered responders when their seizure reduction was ≥ 50%. Results: 14 patients identified. Of them, 50%(n=7) females. Median age (43.5 year. IQR= 28.75-63.25). All refractory to ≥ 2 anti-seizure medications (ASM). Median epilepsy onset was (39.5 years. IQR=23.75-60.25).Median time from diagnosis until received immunotherapy was (15.5 months. IQR=12.75 -21.75). Patients received either IVIG+IVMP (35.7%, n=5) or IVIG alone (28.5%, n=4) or IVIG+IVMP+PLEX (21.4%, n=3) or IVMP alone (7.1%, n=1) or IVIG+IVMP+rituximab (7.1%, n=1). Median follow-up was 25 months.Although early immunotherapy responses were common, sustained response to immunotherapy at last follow-up was only in 21.4% (n=3). Factors confounding determination of immunotherapy efficacy were present in all responders (e.g:concurrent changes in ASM). Conclusions: Our findings suggest that (IMT) in patients with suspected (AAE) but with (-AB) are largely unsuccessful. This suggests an insufficient therapeutic effect after (IMT) or alternatively,non-immune-mediated mechanisms causing this type of epilepsy. Critical evaluations of (IMT)in such cases are needed.
P.019 Interictal burden of migraine: correlations with other measures of migraine burden and effects of galcanezumab migraine-preventive treatment
Authors: Sandoe CH , Lipton RB , Buse DC , Ford JH , Hand AL , Jedynak JP , Port MD , Detke HC
Published: June 2022

Background: Typical migraine clinical trial endpoints assess only ictal burden. Methods: Adults (N=462) with episodic or chronic migraine with previous failure of 2-4 preventive medication categories were randomized 1:1 to 3-month double-blind treatment with placebo or galcanezumab 120mg. Primary endpoint was mean change from baseline in monthly migraine headache days. Migraine Interictal Burden Scale-4 (MIBS-4) measured migraine-related burden on non-headache days for past 4 weeks (0=no burden, 1-2=mild, 3-4=moderate, 5-12=severe). Migraine Disability Assessment (MIDAS), Migraine-Specific Quality of Life Questionnaire (MSQ), Patient Global Impression-Severity (PGI-S), depression (Patient Health Questionaire-9 [PHQ-9]), and anxiety (Generalized Anxiety Disorder Scale [GAD-7]) were assessed. Relationships among measures were assessed at baseline using Spearman’s rank correlation coefficient. Results: MIBS-4 was moderately correlated with PHQ-9 (r=.55) and MSQ total (r=−.53). Other correlations with MIBS-4 were low (GAD-7, r=0.42; MIDAS, r=0.41; PGI-S, r=0.32) or negligible (migraine headache days, r=0.22). After 3 months, from a mean baseline of 13.2 monthly migraine headache days, galcanezumab patients improved by 4.4 vs 1.3 days for placebo (p<.0001). From mean MIBS-4 baseline of 5.5, galcanezumab patients improved by 1.8 vs 0.8 points for placebo (p<.0001). Conclusions: Galcanezumab significantly reduced ictal and interictal burden of migraine. Results suggest interictal burden is a distinct effect of the disease.
P.031 Access to immunoglobulin treatment for CIDP patients during the COVID-19 pandemic
Authors: Brissette V , Poirier L , Massie R , Chalk C , Moore F
Published: June 2022

Background: Immunoglobulin supplies are limited; we aimed to determine if the COVID-19 pandemic was associated with difficulty accessing immunoglobulin treatment for patients diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Methods: A retrospective cross-sectional study was conducted with CIDP patients (n=16, 68.75% female, mean age 60.38 ± 11.32) recruited from three Montreal tertiary care institutions. Patients completed a questionnaire inquiring about changes in their immunoglobulin treatment during the pandemic and about their quality of life. We used weighted chi-squared statistical tests and Cramer’s V correlation ratios to measure associations with treatment change. Results: Eighteen months after the pandemic started, 25% of our population were receiving immunoglobulin treatment at a different frequency, 6.3% were receiving a different dose, 12.5% were receiving a different dose and frequency, and 6.3% were receiving a different treatment. Reasons associated with treatment change were worsening of neurological condition (18.8%; Cramer’s V=0.480; p-value=0.055), improvement of neurological condition (25%; Cramer’s V=0.577; p-value=0.021) and reduced availability of treatment (6.3%; Cramer’s V=0.258; p-value=0.302). There were no significant correlations between lower quality of life (p-value=0.323) or lower Rasch-built Overall Disability Scale score (p-value=0.574) and treatment change. Conclusions: Difficulty accessing immunoglobulin treatment was not significantly associated with treatment change for CIDP patients during the COVID-19 pandemic.
P.033 Detection of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G (MOG-IgG) by live and fixed cell-based assays
Authors: Kumar P , Cruz A , Sodhi H , Waters P , Victor Mgbachi V , Woodhall M , Mousavi A , Oger J , Aziz T , Frykman H
Published: June 2022

Background: MOG-IgG is associated with non-MS demyelinating disease of the optic nerves, spinal cord and brain. Specificity has been issue so we validated the live and fixed MOG-IgG CBAs against the Oxford Autoimmune Neurology Diagnostic Laboratory (OANG) live CBA as a comparator with high specificity. Methods: At BC Neuroimmunology lab (BCNI), 54 MOG-IgG serum samples previously positive by live-CBA at OANG and BCNI were blindly tested by commercial fixed CBA. All 54 MOG IgG positives came from MOG-IgG positive patients. In addition, 256 samples from healthy people and other neurolgic disease were tested. Results: The live MOG-IgG CBA performed at BCNI was 100% concordant (54/54) with OANG live CBA. In contrast, only 49/54 samples were found seropositive by the commercial fixed CBA. The BCNI live-CBA identified 3/256 control samples as positive while 6/256 controls were positive on the fixed commercial CBA. On this cohort the live CBA is 100% sensitive, 98.8% specific and has PPV of 95%. The commercial fixed MOG test is 91% sensitive, 97.6% specific and has PPV of 87.5%. Conclusions: BCNI live MOG-IgG CBAs are in 100% agreement with MOG-IgG. Three positive results in non-MOGAD associated clinical phenotype require further investigation. These data confirm the superiority of the live MOG CBA.
P.035 Impressive MRI findings in the case of iatrogenic osmotic demyelination syndrome: case report
Authors: Greciet N , Rousseau J , Richard A
Published: June 2022

Background: Osmotic demyelination syndrome (ODS) is a known complication of rapid sodium correction. While the pons is classically the most vulnerable region to osmotic shifts, other structures may also be affected. Prognosis varies from death to full recovery, yet we cannot accurately predict a patient’s outcome in the acute phase. Methods: Patient chart, medical imaging, and laboratory findings were reviewed. Results: Here we present the case of a 57-year-old woman seen at our center, who was transferred from a community hospital in the context of ODS after having her serum sodium corrected from 106 mmol/L to 122 mmol/L within 24 hours. She showed depressed mental status, bulbar symptoms, ataxia and respiratory compromise, eventually requiring transfer to the intensive care unit for intubation. MRI of the brain showed striking demyelinating injury at the level of the pons. The patient was discharged to a rehabilitation facility, eventually achieving independence in activities of daily living. Conclusions: This case illustrates canonical neuroimaging findings associated with ODS. Despite extensive initial damage, long-term disability can be mitigated with appropriate care. Future studies seeking to identify specific markers imaging and clinical markers would be of interest to predict functional outcome.
P.042 A novel SOD1 mutation associated with rapidly evolving lower motor neuron syndrome and MR ventral nerve root enhancement
Authors: Perera T , Bencsik C , Pfeffer G , Mobach T
Published: June 2022

Background: Mutations in the Cu/Zn superoxide dismutase 1 (SOD 1) gene are estimated to cause 20% of familial ALS and 1-2% of sporadic cases. Accurate gene variant classification of novel mutations in amyotrophic lateral sclerosis (ALS) has deepened our understanding of clinical phenotypes, provided pathologic insights, and is crucial to incorporating emerging therapies. Methods: We describe a case of a 75-year-old female who presented with a rapidly progressive lower motor neuron syndrome leading to flaccid quadriparesis and complete loss of independence over a five month period. Results: Genetic testing demonstrated a heterozygous variant of uncertain significance in the SOD1 gene with a g > c point mutation at position 382 that has been described in one other patient in available literature. MR of the lumbar spine demonstrated abnormal smooth nerve root enhancement. Conclusions: This novel mutation in the SOD1 gene may be associated with a rapidly progressive phenotype of sporadic ALS. Ventral nerve root enhancement should not exclude a diagnosis of ALS especially in the absence of nodularity or nerve enlargement.
P.048 Objective measures of balance deficits in sensory ganglionopathy
Authors: Smith CB , Beadon K , Berger M , Carpenter M , Washbrook C , Chapman KM
Published: June 2022

Background: Sensory ganglionopathy (SG) is a rare form of neuropathy affecting the dorsal root ganglia and leading to non-length-dependent sensory abnormalities. Although balance problems are frequently reported by patients, a comprehensive balance assessment in SG has not been conducted. This study quantifies balance deficits in SG and examines their relation to patient-reported outcome measures (PROMs). Methods: Prospective data was collected from five participants with SG. Balance assessments included Fullerton Advanced Balance scale, Berg Balance scale, and 360 degree turn. Participants completed PROMs assessing balance confidence (ABC scale), pain, fatigue, quality of life (QoL), and daily activity and participation. Assessment also included neurological exam, nerve conduction studies (NCS) and posturography. Results: All participants had severe SG on NCS with normal strength and significant sensory abnormalities. Balance scores indicated severe balance deficits in all participants and aligned with posturography and truncal sway measures. PROMs revealed low confidence in balance, high levels of pain and fatigue, difficulties with daily activities, and reduced QoL. Conclusions: Although balance testing is not part of routine clinical practice, PROMs and targeted assessment may help monitor patients with SG and their response to treatment. Larger sample sizes are needed to understand the impact of balance on PROMs and optimize bedside balance testing.
P.049 Determining individual substantial response in amyotrophic lateral sclerosis: utilizing a new method on CENTAUR trial results
Authors: Jason T , Mehta L , Wu Y , Timmons J , Paganoni S , Cudkowicz ME
Published: June 2022

Background: In ALS, determining whether individuals have a substantial response to therapy is a challenge for the field. ALS naturally progresses at variable rates and a personalized approach is required to determine if individuals have a substantial response. A new method to evaluate individual response is proposed and applied to data from the CENTAUR trial of sodium phenylbutyrate/ursodoxicoltaurine (PB/TURSO). Methods: In a post hoc analysis, CENTAUR participants whose actual rate of change from baseline in the ALSFRS-R at week 18 was ≤ their own trial baseline progression rate (ΔFS) were defined as having a substantial individual response in slowing ALS progression. Results: Substantial individual response was observed in a greater proportion of participants receiving PB/TURSO (41%, n=87) vs placebo (19%, n=48; P=0.0076). Conclusions: Response versus ΔFS provides a personalized metric to determine substantial individual response in ALS. ΔFS has been shown to be highly correlated with, but to proportionally underestimate, ALSFRS-R decline in clinical trials. Consequently, those who outperform the ΔFS may be considered to have a substantial individual response. Application to CENTAUR data demonstrates a greater proportion of participants with a substantial individual response in the PB/TURSO arm. These methods may enable greater personalization and analysis of individual response in ALS.
P.051 Stroke Care and Neurological Emergency Response Simulation (SCaNERS): High-fidelity acute stroke simulation increases learner confidence in providing acute stroke care
Authors: Archibold K , Graham B
Published: June 2022

Background: Resident physicians often observe stroke alerts before managing them alone, which exposes patients to potential harm from trainees’ lack of experience. Simulation training offers a low-risk environment for skill acquisition. This project assessed learners’ confidence in leading stroke codes before and after completing a stroke simulation training program during neurology rotations at the University of Saskatchewan. Methods: High-fidelity simulation cases were developed encompassing several diagnostic and therapeutic goals of acute stroke care. Standardized patients were trained for increased fidelity. Standardized debriefing was given after each session. Pre- and post-simulation surveys captured learner confidence and cognitive load. Results: Pilot data reveal learners’ confidence and comfort in providing acute stroke care, including thrombolysis treatment decisions, significantly increases after simulation training (n=8; p=0.0006-0.01). They also felt more prepared to conduct future acute stroke care (p=0.009). Skills not directly addressed in simulation did not show significant improvement (p=0.09-1.89). Learners consistently rated the session as requiring high mental effort. Conclusions: Implementation of high-fidelity simulation training leads to significant improvement in learner confidence. Future cases will capture additional objectives and ensure acceptable cognitive load. Ongoing data collection to explore residents’ experiences and knowledge improvement in stroke care and assess local reductions in treatment delays is underway.
P.073 Diagnostic utility of specific abnormal EEG patterns in children
Authors: Ashour M , Minato E , Alawadhi A , Berrahmoune S , Simard-Tremblay E , Poulin C , Myers K
Published: June 2022

Background: CTS and PPR are common EEG findings that are classically associated with CECTS and GGE respectively. PPD and sleep spindles are physiologic phenomenon that occur in respond to intermittent photic stimulation and sleep respectively. Methods: We reviewed EEG studies with CTS, PPR, asymmetric PPD, or asymmetric sleep spindles. For CTS, we determined sensitivity, specificity, PPV and NPV for a diagnosis of CECTS. For PPR, we determined the same diagnostic outcome measures for a diagnosis of GGE or JME. For each of asymmetric PPD and asymmetric sleep spindles, we determined the same diagnostic outcome measures for the presence of a structural abnormality on brain MRI. Results: CTS had 83% specificity and 75% PPV in children with normal neurological examination. PPR had high specificity of 92% and NPV 92% for GGE; for JME, PPR also had high sensitivity (92%). Asymmetric PPD had low sensitivity for structural brain abnormalities (17%), with specificity 80%. In contrast, asymmetric sleep spindles had higher sensitivity and specificity, 44% and 97%, respectively. Conclusions: CTS are seen with CECTS and other conditions. PPR is highly indicative of a GGE, though may be seen other conditions. Relative attenuation of sleep spindles is a more reliable indicator of structural brain malformation than asymmetric PPD.
P.080 Outcomes in Influenza and RANBP2 mutation associated Acute Necrotizing Encephalopathy of Childhood
Authors: Chatur N , Yea C , Ertl-Wagner B , Yeh A
Published: June 2022

Background: Acute Necrotizing Encephalopathy (ANEC) is a rare neuroinflammatory disorder involving the deep grey matter following viral infection and has been associated with the RANBP2 gene. We aimed to evaluate clinical and imaging features in ANEC patients. Methods: This retrospective chart review of ANEC patients (2012-2020) seen at a tertiary pediatric center included analysis of outcomes including ANE-Severity Score, Expanded Disability Status Scale (EDSS) and the modified Rankin Scale (mRS), semi-quantitative imaging scores (degree of swelling or hemorrhage rated 0 (none)-5 (severe/massive)), and dichotomous outcomes including RANBP2 gene status, influenza status. Results: 20 patients were included (Avg. age at presentation 3.5 yrs IQR=3.56., F:M 2.33:1). 3/20 experienced recurrences. All patients with recurrences were positive for RANBP2 mutations. 10/20 patients were influenza positive. 7/20 were RANBP2 mutation positive. We observed higher likelihood of hemorrhage in influenza-positive compared to negative patients (W=78, p=0.048). Kaplan-Meier survival curve analysis revealed that patients without brainstem lesions were more likely to reach minimal/no disability (EDSS<=2) than patients with brainstem lesions (p=0.035). Conclusions: Hemorrhage is more likely to be seen in children with ANEC who are positive for influenza. RANBP2 status was predictive of relapse but not predictive of overall outcome.
P.084 5q spinal muscular atrophy Canadian Paediatric Surveillance Program – 2020-2021 results
Authors: Price T , Hodgkinson V , Innes M , Korngut L , Parboosingh J , Mah JK
Published: June 2022

Background: Spinal muscular atrophy (SMA) is the leading genetic cause of infant death and the second most common autosomal recessive disorder; most cases are due to homozygous deletion of SMN1 gene. Methods: This study uses the Canadian Paediatric Surveillance Program to determine the minimum annual incidence of 5q-SMA from birth to 18 years of age in Canada. The protocol can be accessed at www.cpsp.cps.ca/surveillance. Results: Eighteen cases were reported in 2020-2021. Ten (55%) cases were reported from Ontario and the remaining cases were reported from Atlantic Canada and Western Canada. Their median age was 11 months (IQR 4–21); 61% were male. The most common presenting symptoms were hypotonia and delayed motor milestones in 12 (86%) and 10 (71%) cases respectively. On average, the diagnosis was delayed after onset of symptoms by three months for SMA Type 1, by eight months for Type 2, and by 18 months for Type 3. Twelve (86%) cases received nusinersen as their first disease-modifying treatment. Conclusions: Early recognition and newborn screening are essential to reduce diagnostic delay and enable timely treatment of SMA. Other data sources including the Canadian Neuromuscular Disease Registry and molecular genetic laboratories will be used to estimate the annual incidence of pediatric SMA in Canada.
P.109 Isolated central nervous system lymphoma in the inpatient setting: a case series
Authors: Hennawy M , Marzoughi S , Chen T
Published: June 2022

Background: Isolated central nervous system lymphomas (CNS-L) has non-specific clinical presentations causing delays in diagnosis and treatment. This retrospective case series aims to characterize these challenges in the inpatient setting. Methods: Chart review of biopsy-proven CNS-L cases (n=10) presenting to Vancouver General Hospital from 2018-2020: diffuse (8/10) and intravascular (2/10) large B-cell lymphomas were included. Results: Median age was 69 years (31-83); 50% were female; 9/10 immunocompetent, 1/10 had well-controlled HIV. Neurologic symptoms at presentation: ataxia (7/10), paresis (4/10), dysphagia (4/10), dysarthria (2/10), and cognitive decline (4/10). Median time from symptom onset to admission with paresis, ataxia, dysphagia, or dysarthria was 3 days (1-14), compared to 84 days (28-384) with transient/vague symptoms. Median time from admission to biopsy was 25 days (5-148). 4/10 received steroid prior to biopsy. 1/10 had solitary lesion on MRI, 8/10 had ≥2 lesions. Diagnosed on lumbar puncture (0/10), skin biopsy (1/10), vitreous biopsy (1/10), brain biopsy (8/10), autopsy (1/10). 4/10 survived, 6/10 died; median time from admission to mortality was 133 days (61-342). Conclusions: Many factors lead to delays in diagnosis and treatment of CNS-L, including non-specific clinical presentations and time to brain biopsy for definitive diagnosis. Earlier recognition and reducing biopsy delays may help achieve earlier diagnosis.
P.115 Diagnostic performance of machine learning based MR algorithm vs conventional MR images for predicting the likelihood of brain tumors
Authors: Chatterjee S , Alkhaldi R , Yaadav P , Bethineedi D , Shreya A , Bankole N
Published: June 2022

Background: MRI forms an imperative part of the diagnostic and treatment protocol for primary brain tumors and metastasis. Though conventional T1W MRI forms the basis for diagnosis at present, it faces several limitations. Machine learning (ML) algorithms require less expertise and provide better diagnostic accuracy. Methods: A systematic review of PubMed, Google Scholar, and Cochrane databases along with registries through 1980-2021 was done. Original articles in English evaluating Conventional MRI or ML algorithms. Data was extracted by 2 reviewers and meta-analysis was performed using bivariate regression model. Results: The study protocol was registered under PROSPERO. Twelve studies with 1247 participants were included for systematic analysis and three studies for meta-analysis. ML algorithms had better aggregate sensitivity and specificity (80%, 83.14%) than Conventional MRI (81.84%, 74.78%).The pooled sensitivity, specificity, DOR for the studies were 0.926 (95% CI, 0.840-0.926), 0.991 (95% CI, 0.955-0.998) and 1446.946 (312.634-6692.646) with AUC=0.904 under HSROC. On subgroup analysis, MRS and Random Forest Model had highest sensitivity and specificity (100%,100%;100%,100%), DSC MRI and Deep Neural Network had highest AUC (0.98,0.986). Conclusions: ML algorithm has superior diagnostic performance and faster diagnostic capability once trained than conventional imaging for brain tumors. It has immense potential to be the standard of care in the future.
P.116 Not everything is what it seems, look closer, think deeper: granulomatosis with polyangiitis
Authors: Parra-Farinas C , Alshafai L
Published: June 2022

Background: Granulomatosis with polyangiitis (GPA) is a rare disease of unknown cause. The multitude of manifestations presents significant diagnostic challenges. This is a unique case of GPA with sinonasal, airway, skull base, petrous bones, vascular, and brain parenchyma involvement. Methods: We present a case of a 45-year-old female with a several day history of headache and left hearing loss. MRI brain demonstrated a large erosive enhancing soft process in the sinonasal cavity and nasopharynx. Results: She developed new ipsilateral rightward tongue deviation. A second MRI demonstrated disease progression. It showed posterior pharyngeal wall ulceration, involvement of the skull base foramina, petrous bones, and central bony skull erosion. It demonstrated right hemiglossal edema secondary to right hypoglossal nerve compression at the skull base. There was enhancing soft tissue partially encasing the left petrous internal carotid artery and more extensively encasing and narrowing bilateral intradural vertebral arteries with associated brainstem edema secondary to direct mass effect and new left occipital thromboembolic infarct. She underwent a nasopharyngeal biopsy which demonstrated acute inflammation on a background of GPA. Conclusions: There are no pathognomonic imaging characteristics for GPA. By recognizing the common and less-common imaging features, radiologists play a crucial role in both diagnosing and monitoring the disease activity.
P.117 Initial imaging predicts mortality in severe traumatic brain injuries in pediatric population - a systematic review and meta-analysis
Authors: Goubran D , Batoo D , Linton J , Shankar J
Published: June 2022

Background: The purpose of this systematic review was to synthesize evidence based on existing studies on the ability of initial imaging to predict mortality in severe traumatic brain injuries (TBIs) in pediatric patients. Methods: An experienced librarian searched for all existing studies based on the inclusion and exclusion criteria. The studies were screened by two blinded reviewers. The data was extracted to calculate the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predicted value (NPV), area under the curve (AUC), and receiver operating characteristic (ROC) for extradural hematoma (EDH), subdural hematoma (SDH), traumatic subarachnoid hemorrhage (tSAH), skull fractures, and edema. Results: Of the 3277 studies included in the search, data could only be extracted from 22 studies. There were a total of 2219 patients, 747 females, and 1461 males. 564 patients died and 1651 survived. 293 patients had SDH, 76 had EDH, 347 had tSAH, 244 had skull fractures, and 416 had edema. Seven of the studies had sufficient data to calculate the AUC, ROC, and generate a forest plot for the imaging findings. Conclusions: Out of the different CT scan findings, brain edema had the highest SN, PPV, NPV, and AUC. EDH had the highest SP to predict in hospital mortality.
P.149 High-fidelity simulation-based microsurgical training for neurosurgical residents
Authors: Santyr B , Abbass M , Chalil A , Krivosheya D , Denning L , Mattingly T , Haji F , Lownie SP
Published: June 2022

Background: Mastery of microsurgical skills requires regular hands-on practice. Simulation is increasingly recognized as an important supplement to operative training experience. The live rat femoral artery model is the gold standard model for microneurosurgical skills simulation. We present an 11-year experience incorporating simulation-based microsurgical training into an established Canadian neurosurgery program. Methods: Postgraduate year 2 (PGY-2) neurosurgery residents completed a one-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat vessel training modules were used. Three modules comprised live microvascular anastomosis. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Results: Eighteen participants completed 107 microvascular anastomoses. There was significant improvement in six measurable skills during the curriculum. Mean overall score was significantly higher on the fifth attempt compared to the first attempt for all 3 live anastomotic modules (p<0.001). Each module had a different improvement profile across the skills assessed. The greatest improvement was observed during artery-to-artery anastomosis. Conclusions: This high-fidelity microsurgical simulation curriculum demonstrated a significant improvement in the six microneurosurgical skills assessed, supporting its use as an effective teaching model. Transferability to the operative environment is actively being investigated.
P.153 Traumatic spinal cord injuries among indigenous and non-indigenous peoples of Canada
Authors: Persad A , Renne B , Jeffrey M , Ahmed S , Humphreys S , Kurban D , Rivers C , Cheng C , Wang D , Shen T , Liu X , Christie S , Clarke T , Drew B , Ethans K , Fehlings MG , Linassi A , O’Connell C , Paquet J , Scott L , Fourney D
Published: June 2022

Background: Despite a higher prevalence of traumatic spinal cord injury (TSCI) amongst Canadian Indigenous peoples, there is a paucity of studies focused on Indigenous TSCI. We present the first Canada-wide study comparing TSCI amongst Canadian Indigenous and non-Indigenous peoples. Methods: This study is a retrospective analysis of prospectively-collected TSCI data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2004-2019. We divided participants into Indigenous and non-Indigenous cohorts and compared them with respect to demographics, injury mechanism, level, severity, and outcomes. Results: Compared with non-Indigenous patients, Indigenous patients were younger, more female, less likely to have higher education, and less likely to be employed. The mechanism of injury was more likely due to assault or transportation-related trauma in the Indigenous group. The length of stay for Indigenous patients was longer. Indigenous patients were more likely to be discharged to a rural setting, less likely to be discharged home, and more likely to be unemployed following injury. Conclusions: Our results suggest that more resources need to be dedicated for transitioning Indigenous patients sustaining a TSCI to community living and for supporting these patients in their home communities. A focus on resources and infrastructure for Indigenous patients by engagement with Indigenous communities is needed.
P.158 Middle meningeal embolization for pediatric chronic subdural hematoma
Authors: Ajisebutu A
Published: June 2022

Background: Chronic subdural hematoma (CSDH), although common in the adult and geriatric populations, is a relatively rare condition in pediatric patients. Middle meningeal artery (MMA) embolization is a novel adjuvant endovascular procedure used to minimize the risk of recurrence of CSDH, and its use in pediatric populations is exceptionally rare. Methods: This is a case-report and review of the available literature. Results: A 14 year old male presented to the children hospital after an episode of dysarthria, word-finding aphasia and subtle right sided weakness. MRI revealed a CSDH left cerebral hemisphere with evidence of septations and an arachnoid cyst in the left middle cranial fossa. The patient underwent surgical drainage of the CSDH and subsequent MMA embolization. The patient made an excellent functional recovery with complete resolution of CSDH. Conclusions: Here we report our experience with MMA embolization as an adjuvant therapy for the treatment of a pediatric CSDH. We have found that MMA embolization provides a safe adjuvant therapy in the treatment of CSDH in the pediatric population, lending support to the limited literature of the utility of MMA in this age group. We propose that MMA embolization is safe and potentially efficatious in reducing risk of recurrence in pediatric complex, multi-loculated CSDHs
P.167 Documented growth of a de novo intracranial capillary hemangioma: a case report
Authors: MacLellan A , Easton A , Pickett G
Published: June 2022

Background: Intracranial capillary hemangiomas are rare, particularly in adults, and diagnosis can be challenging. The literature lacks visualization of intracranial capillary hemangioma growth over time. Here we document growth of a de novo intracranial capillary hemangioma, initially interpreted radiologically as a glioma. Methods: We report a case of a 64 year old male with history of HIV, recent Lyme disease and unconfirmed prior COVID-19 infection, who presented with exhaustion and confusion. Imaging demonstrated an intra-axial high T2/FLAIR signal lesion centred in the subcortical white matter of the posterior right temporal lobe. There was faint enhancement, and a few mildly prominent vessels were seen along its anterior aspect. Imaging 2 years prior had not shown the lesion. Stereotactic biopsy was nondiagnostic. Craniotomy and resection was carried out. Results: Pathological examination and immunohistochemistry returned the diagnosis of capillary hemangioma. We review how this case adds to proposed theories of de novo intracranial capillary hemangioma growth. Our patient’s co-morbidities support possible inflammation related triggers for symptomatic progression of these uncommon lesions. Conclusions: This unusual case documents the radiological appearance and progression of a de novo intracranial capillary hemangioma. It represents the first time such growth has been visualized in an adult male.
P.171 Intradural-extramedullary spinal cavernoma with nerve root association: a case report and review of the literature
Authors: McQueen SA , Haji F , Lucar Figueroa E , Sallam Y , Ang L , Duggal N
Published: June 2022

Background: Although 5% of cavernomas occur in the spine, intradural-extramedullary cavernomas are exceptionally rare. We present one such case of cavernoma associated exclusively with a nerve root, and review the literature for similar lesions. Methods: Case Report. A 45-year old male patient presented with a six-month history of numbness and paresthesia affecting his lower extremities bilaterally. MRI demonstrated a 16mm intradural-extramedullary lesion at T3-4, compressing the cord. The lesion was surgically removed en-bloc, requiring root sacrifice. The patient’s symptoms completely resolved post-operatively, and he remained asymptomatic at 3-month follow up. Results: Including the present case, 71 cases of intradural-extramedullary spinal cavernoma have been reported, including 50 with confirmed nerve root involvement. Patients most frequently presented between the ages of 40-59 (41%) with lesions at the lumbar level (54%). Confirmed subarachnoid hemorrhage was present in 14% at presentation, although 23% presented acutely. 49% presented with longstanding/progressive symptoms, and 11% with mixed acute-on-chronic presentation. 37% presented primarily with radiculopathy, 21% with myelopathy, and 11% with pain. Good postoperative recovery was documented in 80% of cases. Conclusions: Intradural-extramedullary spinal cavernomas may demonstrate a propensity for radiculopathy at presentation and exhibit substantial subarachnoid hemorrhage risk. Literature review supports the role of surgical resection.
A.3 A novel recessive TNNT1 congenital core-rod myopathy in French Canadians
Authors: Pellerin D , Aykanat A , Ellezam B , Troiano EC , Karamchandani J , Dicaire M , Petitclerc M , Robertson R , Allard-Chamard X , Brunet D , Konersman CG , Mathieu J , Warman Chardon J , Gupta VA , Beggs AH , Brais B , Chrestian N
Published: June 2022

Background: Mutations in the slow skeletal muscle troponin T (TNNT1) gene cause a congenital nemaline myopathy resulting in death from respiratory insufficiency in early infancy. We report on four French Canadians with a novel congenital TNNT1 myopathy. Methods: Patients underwent lower extremity and paraspinal MRI, quadriceps biopsy and genetic testing. TNNT1 expression in muscle was assessed by quantitative PCR and immunoblotting. Wild type or mutated TNNT1 mRNAs were co-injected with morpholinos in a zebrafish knockdown model to assess for rescue of the morphant phenotype. Results: Four patients shared a novel missense homozygous mutation in TNNT1. They developed from childhood slowly progressive limb-girdle weakness with spinal rigidity and contractures. They suffered from restrictive lung disease and recurrent episodes of rhabdomyolysis. Older patients remained ambulatory into their sixties. Lower extremity MRI showed symmetrical myopathic changes. Paraspinal MRI showed diffuse fibro-fatty involution. Biopsies showed multi-minicores. Nemaline rods were seen in half the patients. TNNT1 mRNA expression was similar in controls and patients, while levels of TNNT1 protein were reduced in patients. Wild type TNNT1 mRNA rescued the zebrafish morphants but mutant transcripts failed to do so. Conclusions: This study expands the spectrum of TNNT1-related myopathy to include a milder clinical phenotype caused by a functionally-confirmed novel mutation.
B.2 Does gender equality exist in the surgical management of degenerative lumbar disease?
Authors: MacLean MA , Touchette CJ , Han J , Christie SD , Pickett G
Published: June 2022

Background: Despite efforts toward gender equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is often unavailable. The purpose of this study was to determine if gender equality exists in the management of degenerative lumbar disease. Methods: Part 1: A systematic scoping review was conducted according to PRISMA guidelines, in order to synthesize the adult surgical literature regarding gender differences in pre- and post-operative clinical assessment scores for patients diagnosed with degenerative lumbar disease.

Part 2: An ambispective cohort analysis (multi-variate logistic regression) of the Canadian Spine Outcomes Research Network registry was performed to address knowledge gaps identified in “Part 1”. Results: Part 1: Thirty articles were identified, accounting for 32,951 patients. Female patients have worse absolute pre-operative pain, disability and health-related quality-of-life (HRQoL). Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males.

Part 2: Data was analyzed for 5,039 patients. Significant gender differences in pre-operative utilization of healthcare resources (medication use, diagnostic testing, medical and allied healthcare professional visits) were identified. Conclusions: Significant gender disparities in clinical assessment scores and the pre-operative utilization of healthcare resources were identified for patients undergoing surgery for degenerative lumbar disease.
B.3 Activated gene pathways in post-infectious hydrocephalus (PIH):: proteogenomics and the PIH expressome
Authors: Isaacs AM , Morton S , Movassagh M , Zhang Q , Hehnly C , Zhang L , Morales D , Townsend RR , Limbrick DD , Paulson JN , Schiff SJ ,   Control of Neonatal Sepsis and Hydrocephalus in Africa (CONSHA) Group ()
Published: June 2022

Background: Proteogenomics, the integration of proteomics and RNASeq expands the discovery landscape for candidate expressed gene networks to obtain novel insights into host response in post-infectious hydrocephalus (PIH). We examined the cerebrospinal fluid (CSF) of infants with PIH, and case controlled against age-matched infants with non-postinfectious hydrocephalus (NPIH) to probe the molecular mechanisms of PIH, leveraging molecular identification of bacterial and viral pathogens. Methods: Ventricular CSF samples of 100 infants ≤ 3 months of age with PIH (n=64) and NPIH (n=36) were analyzed with proteomics and RNASeq. 16S rRNA/DNA sequencing and virome capture identified Paenibacillus spp. and cytomegalovirus as dominant pathogenetic bacteria implicated in our PIH cohort. Proteogenomics assessed differential expression, gene set enrichment and activated gene pathways. Results: Of 616 proteins and 11,114 genes, there was enrichment for the immune system, cell-cell junction signaling and response to oxidative stress. Proteogenomics yielded 33 functionally and genetically associated gene sets related to neutrophil activation, platelet activation, and cytokines (interleukins and interferon) signaling. Conclusions: We identified PIH patients with severe disease at time of hydrocephalus surgery, to have differential expression of proteins/genes involved in neuroinflammation, ependymal barrier integrity and reaction to oxidative stress. Further studies are needed to examine those proteins/genes as biomarkers for PIH.
“I Never Saw as Good a Nature Show Before”: Walt Disney, Environmental Education, and the True-Life Adventures
Authors: Dorn Charles
Published: June 2022

Alongside Walt Disney's animated movies, television programming, and theme parks, scholars have examined The Walt Disney Studios’ True-Life Adventures series of live-action nature documentary films for their impact on popular culture. Historians, however, have mostly overlooked the significance of the True-Life Adventures for student learning about the natural world. Amending this historiographical shortcoming, this essay examines Disney's innovative approach to wildlife filmmaking, describes viewers’ reactions to the True-Life Adventures’ educational qualities, and investigates the Studios’ efforts to use the films to enter the education market. The study breaks new ground by analyzing seldom accessed documents preserved in the Walt Disney Archives both to reveal how students, teachers, and college and university faculty responded to the films and to examine the extension of the nature documentaries through related media.
Beyond glacier-wide mass balances: parsing seasonal elevation change into spatially resolved patterns of accumulation and ablation at Wolverine Glacier, Alaska
Authors: Zeller Lucas , McGrath Daniel , Sass Louis , O'Neel Shad , McNeil Christopher , Baker Emily
Published: June 2022

We present spatially distributed seasonal and annual surface mass balances of Wolverine Glacier, Alaska, from 2016 to 2020. Our approach accounts for the effects of ice emergence and firn compaction on surface elevation changes to resolve the spatial patterns in mass balance at 10 m scale. We present and compare three methods for estimating emergence velocities. Firn compaction was constrained by optimizing a firn model to fit three firn cores. Distributed mass balances showed good agreement with mass-balance stakes (RMSE = 0.67 m w.e., r = 0.99, n = 41) and ground-penetrating radar surveys (RMSE = 0.36 m w.e., r = 0.85, n = 9024). Fundamental differences in the distributions of seasonal balances highlight the importance of disparate physical processes, with anomalously high ablation rates observed in icefalls. Winter balances were found to be positively skewed when controlling for elevation, while summer and annual balances were negatively skewed. We show that only a small percent of the glacier surface represents ideal locations for mass-balance stake placement. Importantly, no suitable areas are found near the terminus or in elevation bands dominated by icefalls. These findings offer explanations for the often-needed geodetic calibrations of glaciological time series.
On Academic Research, Legitimacy, and Fieldwork in Times of Crisis
Authors: Kassem Ali
Published: June 2022

In thinking through the stark differences in how a research project in Lebanon was received in 2018 versus 2020, this paper seeks to reflect on the fragile relationship between academic researcher and community, on the legitimacy of research in moments of crisis, and on the complexity of pursuing decolonial research in the contemporary West Asia North Africa region.
The importance of optimal body condition to maximise reproductive health and perinatal outcomes in pigs
Authors: Muro Bruno BD , Carnevale Rafaella F , Leal Diego F , Almond Glen W , Monteiro Matheus S , Poor André P , Schinckel Allan P , Garbossa Cesar AP
Published: June 2022

Overnutrition or undernutrition during all or part of the reproductive cycle predisposes sows to metabolic consequences and poor reproductive health which contributes to a decrease in sow longevity and an increase in perinatal mortality. This represents not only an economic problem for the pig industry but also results in poor animal welfare. To maximise profitability and increase sustainability in pig production, it is pivotal to provide researchers and practitioners with synthesised information about the repercussions of maternal obesity or malnutrition on reproductive health and perinatal outcomes, and to pinpoint currently available nutritional managements to keep sows’ body condition in an optimal range. Thus, the present review summarises recent work on the consequences of maternal malnutrition and highlights new findings.
Updated Global Reference Models of Broadband Coherent Infrasound Signals for Atmospheric Studies and Civilian Applications
Authors: Kristoffersen S. K. , Le Pichon A. , Hupe P. , Matoza R. S.
Published: June 2022

The International Monitoring System (IMS) infrasound network has been established to detect nuclear explosions and other signals of interest embedded in the station‐specific ambient noise. The ambient noise can be separated into coherent infrasound (e.g., real infrasonic signals) and incoherent noise (such as that caused by wind turbulence). Previous work statistically and systematically characterized coherent infrasound recorded by the IMS. This paper expands on this analysis of the coherent ambient infrasound by including updated IMS data sets with data up to the end of 2020 for all 53 of the currently certified IMS infrasound stations using an updated configuration of the Progressive Multi‐Channel Correlation (PMCC) method. This paper presents monthly station‐dependent reference curves for the back azimuth, trace velocity, and root mean squared amplitude, which provides a means to determine the deviation from the nominal monthly behavior. In addition, a daily Ambient Noise Stationarity (ANS) factor based on deviations from the reference curves is determined for a quick reference to the coherent signal quality compared to the nominal situations. Newly presented histograms provide a higher resolution spectrum, including the observations of the microbarom peak, as well as additional peaks reflecting station‐dependent environmental noise. The aim of these reference curves is to identify periods of suboptimal operation (e.g., nonoperational sensor) or instances of strong abnormal signals of interest.