bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of GRE, ADC and Routine MRI in Distinguishing Parkinsonian Disorders
Authors: Wadia Pettarusp M. , Howard Peter , Ribeirro Manuel Q. , Robblee Jennifer , Asante Abena , Mikulis David J. , Lang Anthony E.
Published: December 2014

Objectives:

To study different radiological signs and sequences including apparent diffusion coefficient (ADC) and gradient echo (GRE) to differentiate degenerative parkinsonian syndromes.

Background:

Multiple system atrophy (MSA), Parkinson's disease (PD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CbD) differ in the pattern of neurodegeneration and cellular damage. Measuring the ADC, GRE sequences for paramagnetic substances and simple anatomical assessments have been reported individually to assist in separating some of these disorders, but have not been compared.

Methods:

brain MRIs from May 2002 to February 2008 were retrospectively evaluated by raters blinded to the clinical diagnosis for predefined MRI signs on T1, T2 and GRE sequences. ADC values were quantitatively measured. Medical records were objectively analyzed using standard clinical criteria for different parkinsonian syndromes.

Results:

195 cases comprising of 61 PD, 15 MSA-P, 7 MSA-C, 21 PSP, 6 Corticobasal syndrome, 21 not fitting criteria and 64 controls were evaluated. 73% of patients with MSA-P had hypointensity of the putamen (compared to the pallidum) on GRE. The specificity of this sign to diagnose MSA-P was 90% versus PD and 76% versus PSP. When GRE hypointensity was combined with atrophy of the putamen the specificity improved to 98% (versus PD) and 95% (versus PSP) without altering the sensitivity. The ADC values were significantly higher in the middle cerebellar peduncle in cases with MSA-C versus controls, PD and PSP (p<0.001).

Conclusions:

The combination of hypointensity and atrophy of the putamen on GRE is useful in differentiating MSA-P from other parkinsonian syndromes.
The Expression of FOXJ1 in Neurogenesis after Transient Focal Cerebral Ischemia
Authors: Huang Yabo , Xu Zheng , Cao Jie , Cao Haibo , Zhang Shiming
Published: December 2014

Objective and Background:

FOXJ1 is a member of the Forkhead/winged-helix (Fox) family of transcription factors, which is required for the differentiation of the cells acting as adult neural stem cells which participate in neurogenesis and give rise to neurons, astrocytes, oligodendrocytes. The expression pattern of FOXJ1 in the brain after cerebral ischemia has so far not been described. In the current study, we investigated the expression pattern of FOXJ1 in the rat brain after cerebral ischemia by animal model.

Methods:

We performed a middle cerebral artery occlusion (MCAO) model in adult rats and investigated the expression of FOXJ1 in the brain by Western blotting and immunochemistry; double immunofluorescence staining was used to analyze FOXJ1's co-expression with Ki67.

Results:

Western blot analysis showed that the expression of FOXJ1 was lower than normal and sham-operated brain after cerebral ischemia, but the level of FOXJ1 gradually increased from Day 1 to Day 14. Immuohistochemical staining suggested that the immunostaining of FOXJ1 deposited strongly in the ipsilateral and contralateral hemisphere in the cortical penumbra (CP). There was no FOXJ1 expression in the ischemic core (IC). The positive cells in the cortical penumbra might migrat to the ischemic core. In addition, double immunofluorescence staining revealed that FOXJ1 was co-expressed with mAP-2 and gFAP, and Ki67 had the colocalization with NeuN, GFAP, and FOXJ1.

Conclusions:

All our findings suggest that FOXJ1 plays an important role on neuronal production and neurogenesis in the adult brain after cerebral ischemia.
Long-term Outcome of Infantile Gratification Phenomena
Authors: Jan Mohammed M. , Al Banji Mohammed H. , Fallatah Baraa A.
Published: December 2014

Background:

Infantile gratification phenomena are self-stimulatory behaviors that are often misdiagnosed as epilepsy. Although the prognosis is thought to be benign, limited long-term follow-up studies exist. This was the objective of our study in addition to exploring the risks of future developmental, behavioral, or neurological abnormalities.

Methods:

Series of consecutive infants with gratification phenomena were identified both retrospectively and prospectively over an eight year period from a single pediatric neurology service. The diagnosis was based on descriptive history, review of videotaped events, lack of neurological or developmental abnormalities, and normal routine electroencephalogram.

Results:

Nineteen infants were followed for 3-11 years (mean 7.1). Their ages ranged between 4-13 months (mean 7) with 79% females. The diagnosis was not reached by the referring physician and 74% were misdiagnosed as epilepsy or movement disorder. The episodes recurred with variable frequency with gradual reduction in number and increase in length of attack-free periods with advancing age. Complete remission was noted in all patients by age 1-3 years (mean 1.9). However, 4 children (21%) developed features of attention deficit hyperactivity disorders (ADHD) on long-term follow up. In this group, the gratification phenomena appeared at a younger age with higher attack frequency.

Conclusions:

Gratification phenomena in infants are benign and self-limited, often spontaneously disappearing by two years of age. A correlation with future ADHD was found; however, larger prospective studies are needed to further examine this possible association.
The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 1
Authors: Seshia Shashi S. , Young G. Bryan
Published: December 2014

The evidence-based medicine (EBM) paradigm, introduced in 1992, has had a major and positive impact on all aspects of health care. However, widespread use has also uncovered some limitations; these are discussed from the perspectives of two clinicians in this, the first of a two part narrative review. For example, there are credible reservations about the validity of hierarchical levels of evidence, a core element of the EBM paradigm. In addition, potential and actual methodological and statistical deficiencies have been identified, not only in many published randomized controlled trials but also in systematic reviews, both rated highly for evidence in EBM classifications. Ethical violations compromise reliability of some data. Clinicians need to be conscious of potential limitations in some of the cornerstones of the EBM paradigm, and to deficiencies in the literature.
Feasibility of a Dual Neurosurgeon-Scientist Career in Canada: A Survey Study
Authors: Girgis Fady
Published: December 2014

Objectives:

Performing ‘good work’ in either neurosurgery or neuroscience alone is a challenge. Despite this, a large number of neurosurgeons divide their careers between the two fields, and attempt to excel in both arenas simultaneously. The purpose of this study is to explore perceptions on whether it is possible to do good work in both neurosurgery and research simultaneously, or whether one field suffers at the expense of the other.

Methods:

This question was put to practicing neurosurgeons via an electronic survey that was distributed to resident and staff neurosurgeons in Canada.

Results:

54 surgeons completed the survey, 32 of whom were current or intended neurosurgeon-scientists. Themes explored through the survey included motives behind the pursuit or absence of research in one's neurosurgical career, the quality and feasibility of a dual career, and alternatives to one individual assuming a dual role.

Conclusions:

The opinions obtained revealed that it is possible to do good work in both neurosurgery and neuroscience simultaneously, but in reality it is very difficult to do. Alternatives to this dual career, such as collaboration between clinical neurosurgeons and pure scientists for example, may help bridge the gap between clinical and research arenas.
Utility of the Canadian Treatment Optimization Recommendations (TOR) in MS Care
Authors: Grand'Maison François , Bhan Virender , Freedman Mark S. , Myles Mary L. , Patry David G. , Selchen Daniel H. , Moriarty Patrick , Traboulsee Anthony L.
Published: December 2014

Objectives:

Criteria for Treatment Optimization Recommendations (TOR) for patients with multiple sclerosis (MS) identify suboptimal response to disease-modifying treatment (DMT). The Canadian TOR (CanTOR) were used to indicate recommendations for treatment switches or treatment maintenance based on relapse, disease progression and magnetic resonance imaging (MRI) criteria in patients. We assessed concordance between the TOR and clinicians' decisions regarding treatment response and identified prevalence of patients with MS receiving DMT meeting medium/high levels of concern according to TOR.

Methods:

Prospective baseline and end-of-study assessments of patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome were conducted in this open-label, 12-month, Phase IV, observational Canadian study.

Results:

Data were reported for 184 patients (female 72%, mean age 39 years) of which 96% had RRMS. The TOR criteria identified 19 (10.3%) patients with suboptimal response to treatment. Twelve patients had ≥1 high level of concern. Two patients had ≥2 medium levels of concern. Concordance between TOR and clinician decision in maintaining treatment was 95.3%. Where treatment change was recommended by the TOR, concordance was 29.4%. Clinicians identified the TOR as the principal reason for changing treatment in 50.0% of cases where the TOR identified suboptimal response. The TOR were considered useful by 70.6% of clinicians when treatment optimization was recommended and by 55.3% when maintaining treatment was recommended.

Conclusions:

The TOR criteria can identify suboptimal response in this patient cohort. Concordance between TOR and clinician decision was high when maintaining treatment was recommended. Usefulness of the TOR was most apparent when treatment optimization was recommended.
Gamma Knife in the Treatment of Pituitary Adenomas: Results of a Single Center
Authors: Zeiler F. A. , Bigder M. , Kaufmann A. , McDonald P. J. , Fewer D. , Butler J. , Schroeder G. , West M.
Published: December 2014

Introduction:

Gamma Knife (GK) radiosurgery for pituitary adenomas can offer a means of tumor and biologic control with acceptable risk and low complication rates.

Methods:

Retrospective review of all the patients treated at our center with GK for pituitary adenomas from Nov 2003 to June 2011.

Results:

We treated a total of 86 patients. Ten were lost to follow-up. Mean follow was 32.8 months. There were 21 (24.4%) growth hormone secreting adenomas (GH), 8 (9.3%) prolactinomas (PRL), 8 (9.3%) adrenocorticotropic hormone secreting (ACTH) adenomas, 2 (2.3%) follicle stimulating hormone/luteinizing hormone secreting (FSH/LH) adenomas, and 47 (54.7%) null cell pituitary adenomas that were treated. Average maximum tumor diameter and volume was 2.21cm and 5.41cm3, respectively. The average dose to the 50% isodose line was 14.2 Gy and 23.6 Gy for secreting and non-secreting adenomas respectively. Mean maximal optic nerve dose was 8.87 Gy. Local control rate was 75 of 76 (98.7%), for those with followup. Thirty-three (43.4%) patients experienced arrest of tumor growth, while 42 (55.2%) patients experienced tumor regression. Of the 39 patients with secreting pituitary tumors, 6 were lost to follow-up. Improved endocrine status occurred in 16 (50.0%), while 14 (43.8%) demonstrated stability of hormone status on continued pre-operative medical management. Permanent complications included: panhypopituitarism (4), hypothyroidism (4), hypocortisolemia (1), diabetes insipidus (1), apoplexy (1), visual field defect (2), and diplopia (1).

Conclusions:

Gamma Knife radiosurgery is a safe and effective means of achieving tumor growth control and endocrine remission/stability in pituitary adenomas.
The Burden of Inpatient Neurologic Disease in a Tropical African Hospital
Authors: Philip-Ephraim E. E. , Eyong K. I. , Chinenye S. , William U. E. , Ephraim R. P.
Published: December 2014

Background:

Neurologic disorders represent a major burden of disease globally and the spectrum ranges from noncommunicable disorders like stroke and neurodegenerative disorders to central nervous system infections.

Objective:

The purpose of the study is to assess the burden of neurological diseases in a tropical environment.

Methods:

A one year retrospective survey of neurological diseases seen at the University of Calabar Teaching Hospital, Nigeria, was evaluated using patients' medical record.

Results:

Neurological diseases constituted 24.2% of all medical conditions seen over a one year period. Stroke was found to be the commonest cause of admissions accounting for 42.1% of the cases followed by peripheral neuropathy (13.8%) and meningoencephalitis (7.2%). The immediate case fatality rate was 33.6%. Fifty two percent were discharged home with various levels of recovery while 12.5% left against medical advice. About 2% were referred to other tertiary health institutions.

Conclusion:

The pattern of neurologic diseases in the local medical wards was not remarkably different from those observed in Nigeria and elsewhere. Stroke remains the most frequent cause of neurologic admissions and mortality in this region is same as observed elsewhere.
Neuroinvasive West Nile Virus Disease in Canada. The Saskatchewan Experience
Authors: Téllez-Zenteno José F. , Hunter Gary , Hernández-Ronquillo Lizbeth , Haghir Edrish
Published: December 2014

Background:

West Nile virus (WNV) is a virus of the family Flaviviridae. The main route of human infection is through the bite of an infected mosquito. Approximately 90% of WNV infections in humans are asymptomatic, but neurologic manifestations can be severe.

Methods:

This study reviews the clinical profile of cases with neuroinvasive West Nile infection (NWNI) reported by the Surveillance program of the government of Saskatchewan in the Saskatoon Health Region (SHR). In 2007, 1456 cases of human West Nile cases were reported by the government of Saskatchewan in the whole province. One hundred and thirteen cases had severe symptoms of NWNI (8%), 1172 (80%) cases had mild symptoms of WNI and 171 (12%) had asymptomatic disease. Three hundred and fifty six cases were reported in the SHR, where 57 (16%) fulfilled criteria for NWNI.

Results:

From the 57 cases, 39 (68%) were females. Nine (16%) patients had a history of recent camping, two (4%) reported outdoor sports and four (8%) reported outdoor activities not otherwise specified. Twenty five patients had headache (43.9%), 25 confusion (42.1%), 23 meningitis (40.4%), 17 encephalitis (29.8%), 14 encephalopathy (24.6%), 11 meningoencephalitis (19.3%), 10 tremor (17.5%), acute flaccid paralysis 10 (17.5%), myoclonus 1 (1.8%), nystagmus 2 (3.5%), diplopia 2 (3.5%), dizziness 2 (3.5%). Three patients died related with comorbidities during admission.

Conclusion:

During a year of high occurrence of WNI in Saskatchewan, 16% of cases developed NWNI. The recognition of neurological complications associated with WNI is important to improve their referral to tertiary centers.
Epidemiological Surveillance of Amyotrophic Lateral Sclerosis in Saguenay Region
Authors: Lareau-Trudel Émilie , Fortin Élizabeth , Gauthier Marianne , Lavoie Sarah , Morissette Érika , Mathieu Jean
Published: December 2014

Objectives:

The Neuromuscular Registry of Saguenay-Lac-Saint-Jean (SLSJ), Québec, Canada was established for epidemiological surveillance of neuromuscular disorders including amyotrophic lateral sclerosis (ALS). The objectives of this study are to analyze the ALS clinical characteristics of the SLSJ population and to determine the incidence rate over time by five year periods since 1985.

Methods:

The Registry was validated by a review of the medical records maintained at the CSSS de Chicoutimi, the regional university hospital and, by the estimation of the number of hospitalizations for ALS patients using the Quebec Hospital inpatient database (MED-ECHO).

Results:

A total of 109 patients were included. Overall, the clinical features of ALS observed in SLSJ population are similar to those described in the literature. We observed a significant increase in the incidence rate of ALS during the 2005-2009 period compared with the previous periods. This is due to a significant increase in the incidence rate among the ≥65 years old group, from 4.68 per 100,000 persons/year (CI 95% 2.88-6.48) during 1985-2004 period to 12.22 (CI 95% 7.43-17.02) during 2005-2009 period.

Conclusion:

Given the small size of the SLSJ population, a longer observation period will be needed to confirm a new steady state incidence of ALS in this region.
Evaluation of a Bicycle Helmet Safety Program for Children
Authors: Cusimano Michael D. , Faress Ahmed , Luong Wilson P. , Lockhart Sally , Amin Khizer , Garland Rhonda J. , Russell Kelly
Published: December 2014

Background:

Helmets have been shown to decrease the risk of brain injury; however, helmets must be worn correctly and fit well in order to be effective. The objective of this study is to determine whether kindergarten-aged children could learn and retain appropriate helmet wearing technique through an educational bicycle safety program.

Methods:

Retrospective analysis of scores in questionnaires administered before and after an educational intervention to kindergarten students four to six years of age. The study took place in Prince Edward Island, Canada. A Wilcoxon Sign-Rank Test was used to determine if there was a significant overall increase in knowledge; McNemar chi-square tests were used to determine if there was an increase in knowledge for individual questions.

Results:

There was significant improvement in pre-test to immediate post-tests scores and pre-test to delay post-test scores when the results were stratified by age, sex, bike riding status, and helmet wearing status (p<0.001 for all comparisons). In particular, correct responses for the questions regarding appropriate helmet distances from the eyes increased from 38.9% in the pre-test to above 90% in the post-tests (p<0.001). Correct responses for the question pertaining to appropriate fitting of helmet straps increased from 71.7% pre-test to above 90% in the post-tests (p<0.001).

Conclusions:

There was improved knowledge of appropriate helmet-wearing technique among kindergarten-aged children as a result of the educational intervention, and knowledge gains were retained for at least one month.
The Diagnosis and Management of Piriformis Syndrome: Myths and Facts
Authors: Miller T. A. , White K. P. , Ross D. C.
Published: December 2014

Piriformis Syndrome (PS) is an uncommon, controversial neuromuscular disorder that is presumed to be a compression neuropathy of the sciatic nerve at the level of the piriformis muscle (PM). The diagnosis is hampered by a lack of agreed upon clinical criteria and a lack of definitive investigations such as imaging or electrodiagnostic testing. Treatment has focused on stretching, physical therapies, local injections, including botulinum toxin, and surgical management. This article explores the various sources of controversy surrounding piriformis syndrome including diagnosis, investigation and management. We conclude with a proposal for diagnostic criteria which include signs and symptoms, imaging, and response to therapeutic injections.
Gamma Knife Radiosurgery of Cavernous Sinus Meningiomas: An Institutional Review
Authors: Zeiler F. A. , McDonald P. J. , Kaufmann A. M. , Fewer D. , Butler J. , Schroeder G. , West M.
Published: December 2014

Introduction:

Stereotactic radiosurgery offers a unique and effective means of controlling cavernous sinus meningiomas with a low rate of complications.

Methods:

We retrospectively reviewed all cavernous sinus meningiomas treated with Gamma Knife (GK) radiosurgery between November 2003 and April 2011 at our institution.

Results:

Thirty patients were treated, four were lost to follow- up. Presenting symptoms included: headache (9), trigeminal nerve dysesthesias/paresthesias (13), abducens nerve palsy (11), oculomotor nerve palsy (8), Horner's syndrome (2), blurred vision (9), and relative afferent pupillary defect (1). One patient was asymptomatic with documented tumor growth. Treatment planning consisted of MRI and CT in 17 of 30 patients (56.7%), the remainder were planned with MRI alone (44.3%). There were 8 males (26.7%) and 22 females (73.3%). Twelve patients had previous surgical debulking prior to radiosurgery. Average diameter and volume at time of radiosurgery was 3.4 cm and 7.9 cm3 respectively. Average dose at the 50% isodose line was 13.5 Gy. Follow-up was available in 26 patients. Average follow-up was 36.1 months. Mean age 55.1 years. Tumor size post GK decreased in 9 patients (34.6%), remained stable in 15 patients (57.7%), and continued to grow in 2 (7.7%). Minor transient complications occurred in 12 patients, all resolving. Serious permanent complications occurred in 5 patients: new onset trigeminal neuropathic pain (2), frame related occipital neuralgia (1), worsening of pre-GK seizures (1), and panhypopituitarism (1).

Conclusion:

GK offers an effective treatment method for halting meningioma progression in the cavernous sinus, with an acceptable permanent complication rate.
Deficiencies in Concussion Education in Canadian Medical Schools
Authors: Burke Matthew J. , Chundamala Josie , Tator Charles H.
Published: December 2014

Background:

Recent reports raise concern that physician knowledge of the identification and management of concussion may be deficient. There is little information known about the adequacy of concussion education provided to physicians or medical students. The present study assesses the concussion curriculum offered at medical schools in Canada.

Methods:

We asked all 17 Canadian medical schools to complete a questionnaire on their concussion curriculum, including the following: year of medical school offered; format/setting; and estimated teaching hours. The responses were organized into three categories: (1) concussion-specific education; (2) head injury education incorporating a concussion component; and (3) no concussion education.

Results:

Replies were received from 14 (82%) of the 17 medical schools in Canada. Of the 14 responding schools, four (29%) provided concussion-specific education, six (43%) offered head injury education that incorporated a concussion component, and four (29%) reported no concussion teaching in their curriculum.

Conclusion:

We found deficiencies in the concussion education curriculum provided in the majority of Canadian medical schools. To address this issue, we recommend that all medical schools should, at a minimum, include a one-hour formal concussion-specific teaching session in an early year of their curriculum to be followed by clinical exposure to concussed patients in the later years of medical school. Future studies will be necessary to evaluate if these recommended curricular enhancements are effective in remedying the reported gaps in physicians' concussion knowledge and whether the improved curriculum translates into better care for patients suffering concussion.
Hemangioblastoma Stromal Cells Show Committed Stem Cell Phenotype
Authors: Welten Cassandra M. , Keats Emily C. , Ang Lee-Cyn , Khan Zia A.
Published: December 2014

Background:

Hemangioblastomas are benign vascular tumors of the central nervous system that occur sporadically or in association with von Hippel-Lindau disease. These tumors are characteristically composed of a dense capillary network with intervening stromal/interstitial cells. To date, the histogenesis of hemangioblastoma remains unclear. We hypothesize that hemangioblastomas arise from a defective mesodermal stem cell, which gives rise to the atypical vasculature.

Methods:

To test our hypothesis, we have characterized the cellular composition of hemangioblastomas by immunophenotyping pluripotent and committed stem cells and vascular endothelial cells.

Results:

Our findings show that hemangioblastoma endothelial cells are positive for CD133, a stem and progenitor cell marker. Vascular endothelial cells also expressed nuclear Oct4. In addition to the endothelium, both CD133 and Oct4 were present in stromal and perivascular cells. Interestingly, neither the endothelium nor the stromal cells expressed Sox2 or Nanog suggesting a committed stem cell phenotype.

Conclusions:

From these findings, we believe that hemangioblastoma stromal cells are committed stem cells producing both vascular cell types. The findings also show an unusual CD133-positive endothelial phenotype in hemangioblastoma.
Array CGH Analysis and Developmental Delay: A Diagnostic Tool for Neurologists
Authors: Cameron F. , Xu J. , Jung J. , Prasad C.
Published: December 2014

Developmental delay occurs in 1–3% of the population, with unknown etiology in approximately 50% of cases. Initial genetic work up for developmental delay previously included chromosome analysis and subtelomeric FISH (fluorescent in situ hybridization). Array Comparative Genomic Hybridization (aCGH) has emerged as a tool to detect genetic copy number changes and uniparental disomy and is the most sensitive test in providing etiological diagnosis in developmental delay. aCGH allows for the provision of prognosis and recurrence risks, improves access to resources, helps limit further investigations and may alter medical management in many cases. aCGH has led to the delineation of novel genetic syndromes associated with developmental delay. An illustrative case of a 31-year-old man with long standing global developmental delay and recently diagnosed 4q21 deletion syndrome with a deletion of 20.8 Mb genomic interval is provided. aCGH is now recommended as a first line test in children and adults with undiagnosed developmental delay and congenital anomalies.
Gamma Knife Radiosurgery for High Grade Glial Neoplasms: A Canadian Experience
Authors: Zeiler F.A. , Kaufmann A.M. , McDonald P.J. , Fewer D. , Butler J. , Schroeder G. , West M.
Published: December 2014

Object:

To review our institutional experience with Gamma Knife (GK) stereotactic radiosurgery in treating focally recurrent high grade glial neoplasms of World Health Organization (WHO) grade III or IV.

Methods:

We conducted a retrospective cohort review of all patients treated with GK for focally recurrent high grade gliomas at our institution between November 2003 and April 2013. Data on age, sex, tumor volume, location and maximal diameter, presenting clinical status, complications and clinical outcome was recorded.

Results:

A total of 33 patients were identified. Four were lost to follow-up. Average post-GK and overall survival was 20.4 months (range: 3 – 72) and 63.3 months (range: 10 – 214) respectively. For WHO grade IV gliomas, the average post-GK and overall survival was 15.8 months (range: 3 – 77) and 40.1 months (range: 13 – 148) respectively. Similarily, for WHO grade III gliomas, the average post-GK and overall survival was 34.9 months (range: 6 – 72) and 136.4 months (range: 22 – 214) respectively. Twenty-two patients (75.9%) had post-GK edema, with 14 requiring dexamethasone and eight being asymptomatic. Four patients (13.8%) had imaging defined radiation necrosis.

Conclusions:

Gamma Knife SRS affords an extension of local tumor control, acceptable morbidity, and potentially prolonged survival, for highly selected patients with focally recurrent high grade glial neoplasms.
Radiologic Patterns of Necrosis After Proton Therapy of Skull Base Tumors
Authors: Korchi Amine M. , Garibotto Valentina , Lovblad Karl-Olof , Haller Sven , Weber Damien C.
Published: December 2014

Background:

Discrimination between radiation necrosis and tumor progression after radiation therapy represents a radiologic challenge. The aim of our investigation is to identify patterns of radiation necrosis on brain magnetic resonance imaging (MRI) and positron emission tomography (PET) with Fluoroethyltyrosin (FET) after proton beam therapy (PBT) for skull base tumors.

Material and Methods:

Five consecutive patients with extra-axial neoplasms were included, presenting a total of eight radiation necrosis lesions (three clival chordomas; two petroclival chondrosarcomas; two women; mean age: 49 ± 18.2 years). Radiation necrosis was defined as the appearance of abnormal enhancement on MRI after PBT decreasing over time, and additional histopathologic confirmation in one patient. MRI and PET imaging were retrospectively analyzed by two experienced radiologists in consensus.

Results:

All lesions were localized close to the primary tumor in the field of irradiation. Three patients showed bilateral symmetrical lesions. All lesions showed T2 hyperintensity and T1 hypointensity. Cerebral blood volume (CBV) was reduced in all available studies. None of the lesions showed a restricted diffusion. FET-PET (three patients) showed a higher uptake in four out of five lesions; three of which had a mean tumor-to-background (TBRmean) uptake lower than 1.95 and FET uptake increasing over time and were correctly classified into radiation necrosis.

Conclusions:

Most radiation necroses were in direct continuity with the primary tumor mimicking tumor progression. The most consistent imaging findings for PBT radiation necrosis are low CBV without restricted diffusion and FET-PET TBRmean lower than 1.95 or increasing uptake over time. Bilateral symmetric involvement may be another indicator of radiation necrosis.
Factors Determining the Clinical Complications of Radiosurgery for AVM
Authors: Machnowska Matylda , Taeshineetanakul Patamintita , Geibprasert Sasikhan , Menezes Ravi , Agid Ronit , Terbrugge Karel G. , Andrade-Souza Yuri , Schwartz Michael L. , Krings Timo
Published: December 2014

Purpose:

To identify the predictors of symptomatic post-radiation T2 signal change in patients with arteriovenous malformations (AVM) treated with radiosurgery.

Materials and Methods:

The charts of 211 consecutive patients with arteriovenous malformations treated with either gamma knife radisurgery or linear accelerator radiosurgery between 2000-2009 were retrospectively reviewed. 168 patients had a minimum of 12 months of clinical and radiologic follow-up following the procedure and complete dosage data. Pretreatment characteristics and dosimetric variables were analyzed to identify predictors of adverse radiation effects.

Results:

141 patients had no clinical symptomatic complications. 21 patients had global or focal neurological deficits attributed to symptomatic edema. Variables associated with development of symptomatic edema included a non-hemorrhagic symptomatic presentation compared to presentation with hemorrhage, p=0.001; OR (95%CI) = 6.26 (1.99, 19.69); the presence of venous rerouting compared to the lack of venous rerouting, p=0.031; OR (95% CI) = 3.25 (1.20, 8.80); radiosurgery with GKS compared to linear accelerator radiosurgery p = 0.012; OR (95% CI) = 4.58 (1.28, 16.32); and the presence of more than one draining vein compared to a single draining vein p = 0.032; OR (95% CI) = 2.82 (1.06, 7.50).

Conclusions:

We postulated that the higher maximal doses used with gamma knife radiosurgery may be responsible for the greater number of adverse radiation effects with this modality compared to linear accelerator radiosurgery. We found that AVMs with greater venous complexity and therefore instability resulted in more adverse treatment outcomes, suggesting that AVM angioarchitecture should be considered when making treatment decisions.
Presurgical Language fMRI and Postsurgical Deficits: A Single Centre Experience
Authors: Wiens Charmaine , Goodyear Bradley G. , Goel Ankur , Federico Paolo , Hader Walter , Goyal Mayank
Published: December 2014

Background:

In this study, we conducted a retrospective investigation of our initial single-centre experience with the clinical use of functional magnetic resonance imaging (fMRI) of hemisphere dominance for language processing (i.e., language lateralization). We demonstrated its association with surgical outcome and its potential impact on surgical planning and patient management.

Methods:

Fifty-two cases were reviewed, covering the period from July 2007 to July 2010. Clinical fMRI reports were examined to determine the hemisphere dominance for language processing. Neurological reports were examined to determine if new language deficits were present post-surgery. Neurosurgeon notes were also reviewed to determine if fMRI had an impact on surgical planning.

Results:

Of the cases reviewed, 49 (94%) generated conclusive fMRI. Eleven (22%) patients exhibited fMRI language lateralization contralateral to pathology; zero of nine of these patients that had surgery experienced post-surgical deficits. Twenty-two (44%) patients exhibited fMRI language lateralization ipsilateral to pathology; three of 13 of these patients that had surgery experienced post-surgical deficits. Sixteen (34%) patients exhibited bilateral lateralization of language; five of 13 of these patients that had surgery experienced post-surgery deficits. Several post-fMRI reports indicated that fMRI results had an impact on surgical planning.

Conclusions:

Our results suggest that fMRI demonstrations of language processing within the hemisphere ipsilateral to pathology (either ipsilateral alone or bilateral) is associated with a greater risk for post-surgical language deficits, and in these cases, fMRI results should be taken into consideration for pre-surgical planning.
Can Behenic Acid (C22:0) Levels be a Prognostic Factor in Glial Tumors?
Authors: Kaplan Metin , Koparan Mehmet , Sari Aysel , Ozturk Sait , Kaplan Serpil Kozan , Erol Fatih Serhat
Published: December 2014

Background:

Inhibition of fatty acid synthase leads to apoptosis in cancers, which leads to high levels of fatty acid synthesis. This indicates that cancer cells depend on fatty acid in order to survive. In this study, we investigated whether or not there was a relationship between the glial tumor grade and free fatty acid level of tumor tissue.

Methods:

Twenty patients who had high grade glial tumors and 20 patients who had low grade glial tumors, were included in the study. Tumors samples were obtained intraoperatively in order to measure the fatty acid levels. The fatty acids were studied in three groups: saturated fatty acids, monounsaturated fatty acids and polyunsaturated fatty acids. They were analyzed with gas chromatography.

Results:

The oleic acid, linoleic acid, eicosadienoic acid, arachidonic acid, and docosadienoic acid levels were high in the tumor tissue of low grade tumors. The myristic acid, palmitic acid, stearic acid, alpha linoleic acid, eicosenoic acid, dihomo-gamma-linolenic acid, docosahexaenoic acid, and ceramide levels were high in the tumor tissue of high grade glial tumors. However, none of these high values were statistically significant. The high values of behenic acid, a saturated fatty acid, in low grade glial tumors were statistically significant.

Conclusion:

High levels of behenic acid in patients with low grade glial tumor is important as it indicates persistence of the tissue integrity and tissue resistance. behenic acid levels can be a prognostic factor in glial tumors.
Review of Awakening Agents
Authors: DeMarchi Ryan , Bansal Vikas , Hung Anthony , Wroblewski Karol , Dua Hemi , Sockalingam Sanjeev , Bhalerao Shree
Published: December 2014

Brain injuries are a serious burden of illness to Canada and the US. Advances in managing head trauma have allowed more patients to emerge from decreased levels of consciousness and helped them cope with neurocognitive, neurobehavioural, and neuropsychiatric deficits. In this article, we review the current (1986-2002) evidence surrounding the pharmacological management of arousal states and the aforementioned neurological sequelae of head injury in either acute or chronic conditions. This article will review the evidence for the use of psychostimulants (methylphenidate), antidepressants (amitriptyline, selective serotonin reuptake inhibitors, and buproprion), Parkinson’s medications (amantadine, bromocriptine, carbidopa/levodopa), anticonvulsants (valproic acid), modafinil (Provigil), lactate, hyperbaric oxygen chamber, electroconvulsive therapy, and transmagnetic stimulation, in patients following a head injury. The review did not include all anticonvulsants, neuroleptics, beta-blockers, benzodiazepines, azospirones or cognitive enhancers. Unfortunately, the quality of the evidence is generally poor, and sometimes conflicting, which in turn results in indecisive guidelines for treating patients. Accepting the inherent flaws in the evidence we feel that this paper may serve as a stepping-stone for future researchers to improve data gathering that targets neurocognitive, neurobehavioural and neuropsychiatric symptoms following a head injury.
Anterograde Ventricular Irrigation During Fourth Ventricle Region Surgery
Authors: Fleetwood Ian G. , Hamilton Mark G.
Published: December 2014

Objective:

To reduce postoperative hydrocephalus following surgery in the region of the fourth ventricle.

Method/technique:

We describe the use of a conventionally placed lateral ventricular catheter to facilitate anterograde ventricular irrigation during surgery in the region of the fourth ventricle. This technique offers a safe alternative to more conventional approaches to fourth ventricular irrigation and obviates the need for placement of a third or fourth ventricular catheter and/or serial lumbar punctures by thoroughly flushing blood and tissue debris from the operative field at the time of surgery.

Results:

Preliminary results spanning a five-year period show a lower incidence in the need for early ventriculo-peritoneal shunts (5%) and delayed ventriculo-peritoneal shunts (10%).

Conclusion:

This technique represents a safe method of reducing hydrocephalus following operative procedures in the region of the fourth ventricle.
Electrogastrography in Patients with Parkinson’s Disease
Authors: Naftali T. , Gadoth N. , Huberman M. , Novis B.
Published: December 2014

Background:

Impaired gastrointestinal motility in Parkinson’s disease may affect absorption of levodopa and contribute to the disabling response fluctuations (RF). In this study gastric myoelectric activity was recorded with electrogastrography in patients with PD and correlated with the duration, severity and the presence of RF.

Method:

Electrogastrography (EGG) was performed in 36 patients with PD of which 22 were men. The mean age was 67 years (48-81), mean duration of disease was 7.07 years (1-20), and mean duration of treatment with levodopa was 5.07 years (1-20). Gastric dysrrythmia was diagnosed when either preprandial or postprandial dysrrythmia for more than 30% of the recording period was detected.

Results:

The EGG was abnormal in 24 of 36 patients. Significant association was found between preprandial dysrrythmia and duration of disease (P=0.002); duration of levodopa treatment (P=0.003), severity of 86RF (P=0.001), but not with age (P=0.076). Out of 18 patients with RF, 17 had at least one pattern of dysrrythmia. In 11 out of the 18 patients without RF, the EGG was normal while the remaining seven had at least one pattern of dysrrythmia.

Conclusion:

Abnormal EGG was quite common in this group of patients with PD, particularly in those with RF. The most common pattern of abnormality was preprandial dysrrythmia, which was positively associated with disease duration and length of levodopa treatment. Although frequently asymptomatic, preprandial dysrrythmia leading to impaired gastric emptying may contribute to irregular absorption of levodopa from the small intestine and contribute to disabling response fluctuations.
Clobazam as Add-on Therapy for Temporal Lobe Epilepsy and Hippocampal Sclerosis
Authors: Montenegro Maria Augusta , Ferreira Claudio Meilman , Cendes Fernando , Li Li M. , Guerreiro Carlos A.M.
Published: December 2014

Background:

Clobazam is a benzodiazepine with known antiepileptic action; however, it is not considered first line therapy in the treatment of epilepsy. The objective of this study was to evaluate the efficacy of clobazam as add-on therapy in adults with temporal lobe epilepsy associated with MRI evidence of hippocampal sclerosis (HS).

Method:

This is a retrospective study, conducted at our epilepsy clinic which evaluated clobazam as add-on therapy in patients with temporal lobe epilepsy and MRI signs of HS. Clobazam was prescribed based on the minimum effective dose up to the maximum tolerated dose.

Results:

Seventy-eight patients met the inclusion criteria (51 women), ages ranging from 16 to 76 years old (mean=42.2). Dosage of clobazam ranged from 5 to 60 mg/day (mean=22.6 mg/day). Clobazam was used from one month to eight years (mean=29 months). Sixteen (20.5%) patients were seizure-free, 20 (25.5%) had more than 75% improvement in seizure control, eight (10%) had more than 50% and 20 (26%) were non responders to clobazam. In 14 (18%) we could not determine seizure frequency during follow-up. The improvement in seizure control lasted for more than one year in 30 (68%) patients.

Conclusion:

Our data suggest that clobazam should be considered as add-on therapy in the treatment of patients with temporal lobe epilepsy associated with MRI signs of HS.
A Spontaneous Recurrent Seizure Bioassay for Anti-Epileptogenic Molecules
Authors: Lyon Angela P. , Wainman Dan , Marone Sandra , Weaver Donald F.
Published: December 2014

Drug design in epilepsy is now tackling a new target - epileptogenesis. This is the process whereby a normal brain becomes susceptible to recurrent seizures. One of the stumbling blocks in the design and discovery of new chemical entities as antiepileptogenics is the implementation of an appropriate biological model. Current models, such as the maximal electroshock model, are models of seizures, not models of epileptogenesis. To develop such a model, we have extended and modified a chronic pilocarpine spontaneous recurrent seizure (SRS) model for the purposes of developing a bioassay with which to screen new compounds for putative antiepileptogenic bioactivity.
An Infant with Central Nervous System Complications of Disseminated Tuberculosis
Authors: Mah Jean K. , Kellner James D. , Kunimoto Dennis , Kaura Deepak , Mah Manuel W.
Published: December 2014

A previously well, nine-month-old, Canadian-born, Caucasian infant presented with one month history of cough, irritability, and poor weight gain. Her past medical history was significant for open-heart surgery at age four months, with repair of a ventricular septal defect, closure of an atrial septal defect, and ligation of patent ductus arteriosus. There were no operative complications. Her development was normal for age. She had received her routine immunizations.There was no known infectious diseases contact or exposure to farm animals.
Fragmentation of the International Humanitarian Order? Understanding “Cultures of Humanitarianism” in East Asia
Authors: O'Hagan Jacinta , Hirono Miwa
Published: December 2014

There is an ever-growing demand in the world for humanitarian action in response to the suffering caused by complex emergencies and natural disasters. Part of the power and appeal of humanitarianism is its universality, that is, the idea that humanitarianism is premised on cross-cultural moral truths and principles and a concern for the alleviation of suffering of humankind, regardless of differences. This idea of universality, however, is being called into question as expressions of humanitarianism and humanitarian actors become increasingly diverse. While Western states and organizations have long dominated the international humanitarian order (IHO), this is no longer the case today, with non-Western governments and societies becoming increasingly important and visible contributors to international humanitarian assistance. At the same time, these new IHO players are contributing to a broader range of perceptions of what constitutes legitimate humanitarianism; and while the concern for the suffering of others may be universal, it is clear that the response to suffering may differ across cultures.
Vulture populations in Uganda: using road survey data to measure both densities and encounter rates within protected and unprotected areas
Authors: POMEROY DEREK , SHAW PHIL , OPIGE MICHAEL , KAPHU GEORGE , OGADA DARCY L. , VIRANI MUNIR Z.
Published: December 2014

Six out of seven vulture species whose global ranges lie largely or wholly within Africa are listed as globally threatened. Since their current distributions individually span up to 39 range states there is a pressing need to develop robust, standardised methods that provide a clear measure of range-wide changes in abundance. Yet, survey methods currently used tend to yield either of two measures: estimates of breeding density, derived mainly from nest counts; or linear encounter rates, derived from road surveys. Here, we present the results of a six-year survey of six vulture species in Uganda, in which we used road counts, in combination with Distance sampling, to determine both encounter rates and densities within protected areas (PAs), and in predominantly pastoral and agricultural areas. In combination, five scavenging species were detected 4–6 times more frequently in PAs than elsewhere, and two species, White-backed Vulture Gyps africanus and Lappet-faced Vulture Torgus tracheliotus, were recorded only within PAs. We estimate that PAs held c.1,300–3,900 individuals of the five scavenging species combined, including c.1,250–2,900 individuals of two Gyps species. We also present national population estimates for two species: White-backed Vulture (c.1,000–2,600 birds) and Lappet-faced Vulture (c.160–500 birds). Although sightings were assigned to only three broad distance bands, Distance sampling provided estimates with a level of precision similar to that achieved for linear encounter rates, but as density estimates; a form more readily comparable with results obtained from other survey types.
Upgraded heart failure therapy leads to an improved outcome of dilated cardiomyopathy in infants and toddlers
Authors: Rupp Stefan , Apitz Christian , Tholen Leonie , Latus Heiner , Ostermayer Stefan H. , Schmidt Dorle , Bauer Jürgen , Schranz Dietmar
Published: December 2014

Objective

Dilated cardiomyopathy is a leading cause of cardiac death in children. Approximately 30% of children die or need cardiac transplantation in the first year after establishing the diagnosis. New strategies are needed to improve the outcome in this high-risk patient population.

Method and results

We present our experience in 38 patients below the age of three years, who were diagnosed with dilated cardiomyopathy and who were treated at our institution between 2006 and 2012. The treatment strategy involved institution of β-blockers and angiotensin-converting enzyme inhibitors as soon as feasible. In selected cases, pulmonary artery banding or intracoronary autologous bone marrow-derived cell therapy was performed. The median age at presentation was six months (range 1–26 months). The median follow-up age was 16 months (range 2–80 months). Kaplan–Meier analysis of survival after dilated cardiomyopathy diagnosis revealed a one-year survival of 97% and a five-year survival of 86%. The rate of freedom from death or heart transplantation was 82% at one year and 69% at five years. Surviving patients who were free of transplantation, at the follow-up at 25 months (3–80 months), showed a significant improvement in left ventricular ejection fraction (from 19±11 to 46±16%) and left ventricular end-diastolic diameter (z-score from 4.6±2.4 to 1.4±1.6). In addition, the levels of B-type natriuretic peptide improved significantly (from 3330±3840 to 171±825 pg/ml).

Conclusion

Our data suggest that the clinical approach described here may result in a markedly improved medium-term outcome in young children with dilated cardiomyopathy. Further studies are required to evaluate whether these approaches reduce end-points such as transplantation or death.
LOCKE'S ERROR?
Authors: Moore Terence
Published: December 2014

In the closing chapters of Book III of An Essay Concerning Human Understanding Locke makes what seems to be an astounding error. What it is and why he appears to do it provides the meat of the tenth Conversation between John Locke and Terence Moore.