bluuebunny/crossref_metadata_2025 huggingface dataset:
P.077 Mixed autoimmune hemolytic anemia: an unusual cause of ischemic
stroke and extensive cerebral microbleeds
Authors: Wan M , Ganesh A , Grassi C , Demchuk A
Published: January 2022

Background: Mixed autoimmune hemolytic anemia
(mAIHA) is a rare autoimmune disorder that results in hemolysis with
thrombotic complications like ischemic stroke. This is the first case report
of cerebral microbleeds secondary to mAIHA. Methods:
A literature review of mAIHA and cerebral microbleeds was conducted using
the PubMed and Ovid MEDLINE databases from 1980 to 2021.
Results: A 76 year old male with congenital
deafness and rheumatoid arthritis presented with diffuse livedo reticularis
and abdominal pain. He had fulminant hemolysis with new neurologic deficits
and altered mental status. CT/CTA of the head and neck were unremarkable. MR
brain revealed extensive cerebral microbleeds and multi-territory ischemic
strokes. He was diagnosed with mAIHA, started on pulse methylprednisolone,
and had no further microbleeds on follow-up MRI. From his clinical picture,
common causes of cerebral microbleeds were ruled out such as cerebral
amyloid angiopathy and hypertension. The pathogenesis of his microbleeds may
be from concomitant severe hypoxia or a prothrombotic state, both previously
reported in the literature. Conclusions: This is the
first case report of extensive cerebral microbleeds secondary to mAIHA. When
a patient develops acute neurologic deficits in the context of mAIHA,
extensive cerebral microbleeds may be present possibly due to concomitant
severe hypoxia versus a prothrombotic state.
P.078 Clinical Milestones in PSP and MSA may be Appropriate Triggers for
Palliative Care Intervention
Authors: Bessemer R , Gofton T
Published: January 2022

Background: Progressive supranuclear palsy (PSP)
and multiple system atrophy (MSA) are progressive neurodegenerative
disorders with complex symptom burden and unpredictable disease
trajectories. The ideal timing of palliative care interventions is uncertain
given the variable natural history of both diseases.
Methods: A systematic review was conducted to
identify publications investigating predictors of survival in PSP and MSA. A
medical librarian assisted to ensure comprehensive search strategy. Relevant
literature on palliative care in PSP and MSA was also reviewed. Results from
both searches were qualitatively combined in order to suggest triggers for
targeted palliative care throughout the disease trajectory.
Results: ‘Milestones’ are well documented and
clinically relevant disease points that prompt further care. Important
milestones include: frequent falls, cognitive impairment, unintelligible
speech, severe dysphagia, wheelchair dependence, urinary catheterisation,
and nursing home placement. PSP-Richardson syndrome accumulates milestones
earlier than PSP-Parkinsonism or MSA. Many PSP patients already have falls
and cognitive impairment at the time of diagnosis. Time from milestone to
death is variable. Conclusions: Milestones can be
used to trace disease progression and help predict survival. Clinical
milestones are likely to be important triggers for targeted palliative care
interventions including the early incorporation of a palliative approach to
care or referral to specialised palliative care services.
P.087 Successful response to rituximab in a patient with Aβ related
angiitis
Authors: Lemoine É , Nehme A , Rioux B , Panzini M , Richard A
Published: January 2022

Background: Aβ-related angiitis (AβRA) is a rare
presentation of cerebral amyloid angiopathy, where vasculitis results from
an auto-immune reaction to amyloid deposits in leptomeningeal and cortical
vessel walls. Anti-CD20 monoclonal antibodies, such as rituximab, have
demonstrated efficacy in systemic small vessel vasculitides, particularly in
refractory cases. The efficacy of rituximab in AβRA remains unknown.
Methods: Patient chart, functional measures, and
laboratory findings were reviewed from the time of patient admission until
12 months after discharge. Results: A 61-year-old man
presented with headache and altered mental status. Brain MRI revealed
multiple cortical infarcts, leptomeningeal enhancement, and cortical
microbleeds, and brain biopsy ultimately confirmed the diagnosis of AβRA.
The patient developed new ischemic lesions despite corticosteroid pulse, and
intravenous cyclophosphamide was halted after four weeks due to iatrogenic
acute hepatitis. Rituximab was initiated and led to sustained clinical
improvement with no subsequent relapses. Maintenance therapy involved
gradually tapered low-dose oral steroids and rituximab at 6- and 12-months
post-induction. Conclusions: This report suggests
that rituximab may be effective in inducing remission and preventing
relapses in biopsy-proven case of AβRA. Controlled studies are needed to
better assess the efficacy and tolerability of anti-CD20 antibodies in
cerebral vasculitis.
P.088 Dysautonomia and Diabetes: A Prodrome to Fatal Familial Insomnia
(FFI)
Authors: Liu RR , Bendahan N , Briggs DE , Jansen GH , Taylor S , Lomax LB
Published: January 2022

Background: Fatal Familial Insomnia (FFI) is an
autosomal dominant multisystem prion disease, with sleep disorders often
being the first presentation. Although autonomic dysfunctions are key
features, the frequency and timing vary between reports, and may accompany
early insomnia. Moreover, endocrine changes are reported, but diabetes
rarely is - with unclear timing of onset in relation to the insomnia.
Methods: N/A Results: Here
we present a 46-year-old previously healthy male, who within 22 months prior
to the onset of sleep disturbances, developed hypertension and diabetes.
Then within 3-4 months after onset of sleep disturbances development
tachycardia and diaphoresis. His sleep continued to deteriorate, and later
developed bulbar impairment, ataxia, diplopia, sleep apnea and cognitive
decline. He passed away 20 months from onset of insomnia. Polysomnography
showed status dissociates and central apnea. He had positive genetic
testing, PRNP c.532G>A (p.Asp178Asn) and PRNP c.385A>G (pMet129Val), a
pathological confirmation, and a positive family history
Conclusions: Here diabetes and hypertension
significantly preceded sleep disturbances, and tachycardia and diaphoresis
developed shortly after. This illustrates that dysautonomia and endocrine
dysfunction may be unrecognized prodromes in some cases of FFI, and could be
an early marker of clinical disease onset and therapeutic interventions,
especially in genetically confirmed asymptotic patients.
P.089 A report of a patient presenting with orbital apex syndrome
secondary to NK cell lymphoma (nasal type)
Authors: Shahab IU , Chalchal H , Kirk A , Moulton K
Published: January 2022

Background: Orbital apex syndrome (OAS) can be
caused by a broad range of disorders. There are several challenges present
in the evaluation of these patients and in reaching a final diagnosis. We
report the case of a 69-year-old male who presented with OAS that was
determined to be secondary to a rare malignancy (NK cell lymphoma, nasal
type). Methods: We analyze the pitfalls and
diagnostic delays in this patient’s evaluation. Furthermore we propose a
work up for undifferentiated cases of OAS. Results:
To accurately diagnose the underlying cause of OAS, a direct biopsy should
be obtained whenever possible. The appropriate imaging sequences should be
arranged as lesions in this region can be easily missed. Adjunct tests
include assessment in the serum and CSF for granulomatous and infectious
diseases, along with chest imaging. As many causes are PET enhancing, PET CT
is a useful modality for identifying sites for biopsy.
Conclusions: OAS can provide a diagnostic
challenge for clinicians, however a systematic approach can help determine
the underlying etiology.
P.092 Successful implementation of a supported conversation program on an
acute stroke unit
Authors: Whelan K , Haarstad M , Feldbruegge B , Jacobi A , Mayo C , Hautz T , Heyer C , Graham B , Hunter G
Published: January 2022

Background: Aphasia is a life alerting deficit
that affects up to 40% of people living with stroke. Barriers to
communication ultimately impacts the care aphasic patients receive, as well
as functional recovery. The Canadian Stroke Best Practice Recommendations
suggest early and frequent language interventions to improve patients with
aphasia quality of life, mood, and social outcomes.
Methods: A supported conversation (SC) program
(colloquially named The Aphasia Club) was implemented on the Acute Stroke
Unit (ASU). The program included aphasia awareness and assessment training,
as well as creation of an aphasia tool kit and discipline specific
aphasia-friendly resources. Staff were encouraged to complete a 1-hour
independent course on SC through the Aphasia Institute. Speech and language
pathologists (SLP) offered an additional 30-minute in-person teaching
session with interdisciplinary practice professionals. Following SLP
assessment, personalized communication profiles were created for patients
with aphasia to help staff understand the most useful strategies for
communication. Results: More then 50
interprofessional staff members took SC training. Staff reported increased
levels of knowledge and confidence when communicating with aphasic patients.
Conclusions: A supported communication program
was successfully implemented on an ASU. Planning appropriate communication
interventions can assist interdisciplinary professionals in their ability to
support patients through their stroke journey.
P.093 Implementation of virtual interdisciplinary bedside rounds on an
acute stroke unit
Authors: Whelan K , Copeland J , Cadieu K , Taylor K , Maley S , Hunter G , Graham B
Published: January 2022

Background: The novel corona virus pandemic
presented the Saskatoon Stroke Program with challenges related to patient-
and caregiver-centered communication. Keeping all parties informed of a
patient’s health status and plan of care in the setting of extreme
visitation restrictions was difficult. Virtual interdisciplinary bedside
rounds (VIDR) were introduced to enhance communication for stroke patients.
Methods: A video conferencing application was
adopted by the Saskatchewan Health Authority. Consent to participate was
obtained by a social worker. Bedside nurses facilitated patient
participation in VIDR on either a tablet or workstation on wheels, while
caregivers were able to attend virtually. Each team member accessed the VIDR
from an individual device to maintain social distancing. A structured
questionnaire has been initiated to capture participant reported experiences
and satisfaction with VIDR (data collection ongoing).
Results: Most patients and caregivers were
amiable to participate in VIDR. Challenges included: accessing appropriate
technology for both family and staff members; rural and remote internet
reliability; and maintaining a reasonable duration of rounds. There was
overwhelming anecdotal positive feedback from participants.
Conclusions: We implemented VIDR to enhance
communication during the pandemic. Caregivers felt connected to the care
team and up-to-date in the plan of care.
P.098 The Epilepsy Surgery Experience in Children with Infantile Spasms
at the Hospital for Sick Children
Authors: Gettings J , Shafi S , Boyd J , Snead O , Rutka J , Drake J , McCoy B , Whitney R , Go C
Published: January 2022

Background: Infantile spasms (IS) is an epileptic
encephalopathy, characterized by epileptic spasms, hypsarrhythmia, and
developmental regression. This is a retrospective case series detailing the
experience in children with IS who have undergone epilepsy surgery at The
Hospital for Sick Children (HSC). Methods: Records of
223 patients from HSC were reviewed. Patients were included if they had a
current or previous history of IS with a lesion detected on MRI/PET scan who
underwent epilepsy surgery. Results: Nineteen
patients were included. The etiology of IS was encephalomalacia in six
patients (32%), malformations of cortical development in 11 patients (58%),
atypical hypoglycaemic injury in one patient (0.5%), and partial
hemimegalencephaly in one patient (0.5%). The median age at the onset of IS
was five months. The median age at surgery was 18 months. Nine patients
(47%) underwent hemispherectomy and 10 patients (53%) underwent
lobectomy/lesionectomy. Fifteen patients (79%) were considered ILAE Seizure
Outcome Class 1. Developmental outcome was improved in 14/19 (74%) and
stable in 5/19 (26%) patients. Conclusions: Even with
a generalized EEG pattern such as hypsarrhythmia, patients should be
considered for focal resective surgery. Early surgical intervention shortens
the duration of active epilepsy thus limiting the potentially irreversible
effects of on-going seizures.
P.099 Generator replacement with cardiac based VNS device in children
with drug-resistant epilepsy
Authors: Hadjinicolaou A , Jain P , Yau I , Whitney R , Rutka JT , Go CY
Published: January 2022

Background: We aimed to study the proportion of
patients with DRE and pre-existing VNS device, who show improvement of at
least one class in McHugh seizure outcome classification at last follow up
after generator replacement with cardiac based VNS device.
Methods: We retrospectively reviewed children
with DRE with the older VNS model (102) who underwent battery replacement
with the AspireSR®, model 106 since September 2016 at our institution. We
assessed the seizure outcomes since the first VNS device insertion till the
last follow up after AspireSR® (with cardiac-based seizure detection) using
McHugh seizure outcome classification. Results: The
study population was comprised of 15 patients. The mean age at seizure onset
was 2.7 years old, with mean age of initial VNS1 placement being 10.1 years
and mean age of replacement with VNS2 being 14.9 years of age. Three of the
fifteen patients had reported status epilepticus prior to initial VNS
insertion, and none reported episodes following insertion. Two patients
showed at least one class improvement in McHugh seizure outcomes at last
follow up after VNS2. Conclusions: Through our
preliminary data at the present time, we note that the majority of our
patients maintains their seizure control following replacement with VNS2
with a few showing improvement.
P.101 Response to high dose nocturnal diazepam in children with
ESES
Authors: Kiani H , Go C , Jones KC , Connolly MB , Smith M , RamachandranNair R
Published: January 2022

Background: To assess the response to high dose
daily nocturnal diazepam (HDD) in children with encephalopathy associated
with electrical status epilepticus in sleep (ESES).
Methods: A prospective cohort of patients (4-12
years), newly diagnosed with ESES, initiated on the first course HDD, was
followed for ≤ 1-year. Sleep EEG scores (SES) pre and post HDD were
evaluated. An EEG grading system based on both sleep spike wave index (sSWI)
(Grade: 1-4) and distribution of epileptiform discharges (Grade: 0-4) was
used and summed to yield an aggregate SES (ASES) (Grade: 1-8).
Results: Eighteen eligible children (M:F 12:6;
median age, 7.6 years) were initiated on first course HDD (median, 0.5
mg/kg/d). sSWI decreased from 85.7% (mean, SD 13.9) to 32.6% (mean, SD 37.1)
at subsequent EEG (95% CI = -70.60- -35.62; p < 0.001). ASES decreased
from 6.5 (SD 1.3) to 3.1 (SD 1.9) (95% CI = -4.17- -2.60; p < 0.001). EEG
relapse after a period of improvement occurred in 10 children. Minimal
response to HDD occurred in 2 children. Five patients manifested mild side
effects; behavior (2), hyperactivity (2), and lethargy (1).
Conclusions: HDD safely and significantly reduces
both SWI and aggregate sleep EEG score in children with ESES.
P.106 Intravenous lacosamide use in pre-school children
Authors: Laflamme G , Héroux C , Thibeault-Eybalin M
Published: January 2022

Background: Data on intravenous lacosamide use in
young pediatric patients is scarce, especially of pre-school age.
Methods: We retrospectively reviewed the medical
records of all patients less than 6 years old who received intravenous
lacosamide at our tertiary pediatric hospital. Data on dose, timing and
order of administration was collected. Clinical and electrographic response
was independently assessed with EEG interpretation blinded to time of
administration. For adverse effects surveillance, heart rate was noted
before and 1 hour after dose. Results: Eleven
patients (8 boys), received lacosamide between 2013 and 2018. Mean age was 2
years (11 days – 5,3 years). Medical indications were: refractory status
epilepticus (n=6), repetitive seizures (n=4), and inability to take oral
lacosamide (n=1). On average, lacosamide was the fifth
(1st-8th) IV antiepileptic
drug administered 78 hours (SD 11 hours) after presentation. The most
frequent dose was 5 mg/kg. Clinical response was confirmed in 7 patients,
while electrographic response was proven in 3 patients. Seizure relapse at
24 hours was noted in 6 patients. No bradycardia occurred post-lacosamide.
Conclusions: Although very safe, therapeutic
response to lacosamide in young pediatric patients was inconclusive, mostly
due to delay in administration, suboptimal dose, and high number of other IV
antiepileptic drugs previously given.
P.112 5q Spinal Muscular Atrophy Canadian Paediatric Surveillance Program
- 2020 Results
Authors: Price T , Hodgkinson V , Innes M , Korngut L , Parboosingh J , Mah JK
Published: January 2022

Background: Spinal muscular atrophy (SMA) is the
leading genetic cause of infant death and the second most common autosomal
recessive disorder; the majority of 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 complete protocol can be accessed at
www.cpsp.cps.ca/surveillance. Results: Eleven cases
were reported in 2020. Five (45%) cases were reported from Ontario and the
remaining cases were reported from Atlantic Canada and Western Canada. Their
median age was 12 months (IQR 6–21); 64% were male. The most common
presenting symptoms were delayed motor milestone and hypotonia in 7 (64%)
cases. On average, the diagnosis was delayed after the onset of symptoms by
three months for SMA Type 1, by eight months for Type 2, and by 18 months
for Type 3. Eight (73%) 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.115 Vessel Wall Imaging of Unusual Childhood Strokes: a Pediatric Case
Series
Authors: Albassam FF , Muthusami P , Dlamini N
Published: January 2022

Background: MR-based vessel wall imaging (VWI)
has gained influence in the clinical investigations, and management of
pediatric strokes. Limitations still exist in interpreting it as a singular
modality. Methods: We present 4 pediatric stroke
cases with VWI enhancement. Results: Case 1. 4-year
old boy with sickle cell anemia, who developed encephalopathy during a
hemolytic crisis. MR-VWI revealed bilateral extracranial internal carotid
enhanced narrowing, deemed a secondary vasculopathy, with resolution upon
follow-up.

Case 2. 16-year old male presented with left
middle cerebral artery (MCA) infarction. VWI revealed left internal carotid
terminus and proximal MCA enhancement. Conventional angiography showed
abnormalities in mesentric and hepatic arteries. Stability sustained on
anticoagulation and immunosuppressive therapy.

Case 3. 10-year old girl, developed bilateral MCA
infarctions with enhanced extracranial segments of both ICAs, and narrow
PCAs, consistent with Moyamoya vasculopathy. Improved on combined
immunosuppressive and anticoagulation therapy.

Case 4. 13-year old boy had an episode of right
facial weakness, with a normal neurological exam; with enhancement and
narrowing in the left extracranial ICA, likely an intramural hematoma from
dissection. He responded to dual anticoagulation therapy.
Conclusions: In conclusion, these cases
illustrate similarities in vessel wall imaging abnormalities under different
clinical contexts, with practical utility in longitudinal follow-up and
prognostication.
P.125 Discriminating sharp-wave ripples and interictal epileptiform
discharges in patients with mesial temporal epilepsy using intracranial EEG
recordings
Authors: Mortazavi N , Khaki M , Gilmore G , Burneo J , Steven D , Martinez-Trujillo J , Suller-Marti A
Published: January 2022

Background: Interictal epileptiform discharges
(IEDs) are known as epilepsy biomarkers for seizure detection, and It is
essential for clinicians to detect them from from physiological events with
similar temporal frequency characteristics. Methods:
We analyzed the SEEG recordings obtained from patients with
medically-resistant epilepsy (MRE) implanted with DE at the Western
University Hospital Epilepsy Unit. The data were cleaned, denoised, montaged
and segmented based on the clinical annotations, such as sleep intervals and
observed Ictals. For event detection, the signal waveform and its power were
extracted symmetrically in non-overlapping intervals of 500 ms. Each
waveform’s power across all detected spikes was computed and clustered based
on their energy distributions. Results: The
recordings included thirteen sessions of 24 hours of extracellular
recordings from two patients, with 312 hours extracted from four hippocampus
electrodes anterior and posterior hippocampus. Our results indicate IEDs
carrying the most different characteristics in the bands [25-75] Hz; SWR, on
the other hand, are distributed between [80-170] Hz.
Conclusions: Our algorithm detected and
successfully distinguished IED from SWRs based on their carrying energy
during non-sleep periods. Also, the most powerful spectral features that
they were distinguished from occur in [15-30] Hz and [75-90] Hz.
P.128 Quantitative EEG Detects REM Sleep Microstructure
Authors: Toutant D , Ng M
Published: January 2022

Background: Rapid eye movement sleep (REM) is
divided into phasic and tonic microstates. Phasic REM is defined by presence
of REMs with reportedly greater antiepileptic effect. We assessed whether
quantitative EEG (QEEG) software can detect REM microstates.
Methods: We applied artifact reduction and
detection trends from QEEG software (Persyst 14) on 18 patients undergoing
30 day-night high density EEG recordings in the epilepsy monitoring unit. We
identified phasic REM as 10-second epochs of previously human-scored REM
that demonstrated presence of either vertical or horizontal eye movements on
the QEEG artifact detection panel. Remaining epochs were identified as tonic
REM. Results: Out of 91.2 average minutes of REM
(range 24.5-167.5) per recording, a mean of 2.5% (range 0-18.9%)
demonstrated eye movements intensive enough for QEEG artifact detection to
be identified as phasic REM. On average, only 40% (range 0-500%) of eye
movements per recording was flagged as vertical.
Conclusions: These findings provide
proof-of-concept that QEEG can automatically assess REM microstructure by
readily detecting phasic and tonic REM. These findings also confirm that
most REMs are horizontal. Having the ability to easily and automatically
detect phasic versus tonic REM can help further future studies examining the
antiepileptic effect of REM sleep.
P.132 Investigation of Simulation-Based Lumbar Puncture Teaching
Paradigms for Novice Learners
Authors: Gariscsak PJ , Braund H , Haji F
Published: January 2022

Background: Simulation-based educations’
prevalence within clinical neuroscience is on the rise, however
investigation into what environment is most conducive to optimizing learning
performance is limited. We aimed to determine whether training a
simple-to-complex (progressive) sequence would result in superior learning
compared to complex-to-simple (mixed) or complex-only sequences.
Methods: A three-arm, prospective, randomised
experiment was conducted to determine the effects on novice learner LP
performance and cognitive load during learning and a very complex simulated
reality assessment test 9-11 days later. Results:
During learning, sterility breaches decreased linearly over time (p<.01)
with no group differences, and accuracy was higher in the progressive group
compared to complex-only (p<.01) and trended in the mixed group
(p<.09). Across the learning phase cognitive load increased in the
progressive group (p<.01) and decreased across the mixed group
(p<.01). At assessment, there were no group differences in number of
sterility breaches (p=.66), needle passes (p=.68) or cognitive load (p=.25).
Conclusions: Contrary to our hypothesis,
equivocal assessment performance was found across groups. Our results
suggest that successive progression in complexity of simulation does not
increase novice learner outcomes. Further, a “one-size fits all” approach to
simulated environment complexity in clinical neurosciences education may be
warranted given equivocal learning and less resources necessary.
P.138 A systematic review of the incidence and prevalence of
Neurofibromatosis type 1 and 2
Authors: Lee J , Chopra M , Kim R , Parkin P , Barnett Tapia C
Published: January 2022

Background: Neurofibromatosis 1 and 2 (NF1 and
NF2) are autosomal dominant genetic disorders caused by mutations in tumour
suppressor genes. Methods: We conducted a systematic
review of the incidence and prevalence of NF1 and NF2 in OVID Medline, OVID
Embase, Web of Science, and Cinahl. We included studies until February 19,
2021, that identified cases based on established criteria. Studies were
appraised for quality using the Joanna Briggs Institute Prevalence Critical
Appraisal tool. Pooled incidence and prevalence rates were estimated through
meta-analysis. Results: Of 1,936 studies, 1,866 were
irrelevant after title and abstract screening. Sixteen of 69 studies with
full text assessment were included for full review: 13 regarding NF1 and 6
regarding NF2. Incidence rates for NF1 and NF2 ranged from 1/11,494 to
1/1,871 and 1/62,185 to 1/33,000 respectively. Prevalence rates for NF1 and
NF2 ranged from 1/6,238 to 1/1,001 and 1/600,000 to 1/56,161 respectively.
Meta-analysis will be presented at the conference.
Conclusions: An accurate estimate of the
incidence and prevalence of NF1 and NF2 will offer more insight into health
resource allocation. Increased funding and resources for the development of
early diagnostic and treatment tools for NF1 and NF2 may improve the quality
of life of patients.
P.139 Random Neural Network Features in Patients with Aggressive Multiple
Sclerosis Undergoing Autologous Hematopoietic Stem Cell Transplant
Authors: Melkus G , Hamwi M , Thebault S , Walker L , Chakraborty S , Torres C , Aviv RI , Freedman MS
Published: January 2022

Background: Objective markers of disease
progression are needed for patients with multiple sclerosis (MS). Increased
randomness in neural networks is hypothesized to be an important cause of
morbidity that can be objectified using graph theory.
Methods: We use voxel-based structural similarity
determined from T1-weighted MRI scans of 23 patients with MS receiving
autologous stem cell transplant (ASCT) to compute cortical covariance
network parameters. We examine associations between measures of cortical
integration or segregation and biochemical/clinical measures of cortical
health or function using Spearman correlation coefficients. P<0.05 was
considered significant. Results: Path length increase
was associated with markers of greater inflammation (ρ=0.56,P<.046) at
baseline and reduced Naa/Cr ratio (P<.041) at 12 months. Reduced lambda
was associated with markers of greater grey matter atrophy
(ρ=0.55,P<.019) after 12 months and lower cognition (ρ=0.56,P<.008) at
12 months. Reduced clustering was associated with higher neurofilament
(ρ=-0.68,P<.010) at baseline, greater white matter atrophy
(ρ=0.62,P<.006) after 12 months, lower 2-second PASAT performance
(ρ=0.56,P<.011) at baseline, and reduced Naa/Cr ratio (P<.001) at 12
months. Conclusions: Reduced cortical integration and
segregation (random network features) co-occur with unfavourable markers of
cortical health and function in patients with MS receiving ASCT. Network
features show promise as important longitudinal markers of patient status
and progression.
P.143 How well can neuroradiologists localize clinical signs?
Authors: Curtis C , Pauranik A
Published: January 2022

Background: A basic understanding of localization
for a given set of focal neurological deficits is essential for accurate
acquisition and interpretation of neuroimaging. Relying on often-limited
clinical information, neuroradiologists must choose the most appropriate
imaging modality and tailor a study to best identify the culprit lesion to
allow for accurate interpretation. Methods: A
multiple-choice quiz was designed including clinical vignettes localizing to
lesions within the central (CNS) and peripheral nervous systems (PNS). The
quiz was pilot-tested and refined before distribution as an electronic
survey to practicing neuroradiologists and fellows within newsletters from
the American Society for Neuroradiology and Canadian Neurological Sciences
Federation. Results: The quiz was begun by 45
neuroradiologists and completed in its entirety by 22. Most respondents were
working at urban academic/teaching hospitals(81%) in the USA(42%). The
majority (90%) report no clinical neurology rotation during their training.
Respondents identified a high proportion (88%) of correct answers in
questions about brainstem localizations. Fewer correct answers were selected
in questions describing seizure semiology (44%) or flaccid weakness (59%).
Conclusions: The small size of our study limits
interpretation and generalizability of the findings. Identification of a
potential gap in neuroradiology education relating to localization of more
complex CNS and PNS presentations merits further exploration.
P.152 Efficacy of Dorsal Root Ganglion Stimulation for Post Surgical
Neuropathic Pain
Authors: Sahjpaul R , Varshney V , Osborn J
Published: January 2022

Background: The dorsal root ganglion (DRG) has
been established as an important structure in the development and modulation
of chonic neuropathic pain and has demonstrated superiority over spinal cord
stimulation in the management of challenging neuropathic pain conditions,
including complex regional pain syndrome and chronic post-spine surgery
neuropathic pain. DRG has only been available in Canada for patient
application since January 2020. The St Pauls Hospital Neuromodulation
Program was one of the first Canadian centers to offer this procedure.
Methods: We reviewed our early experience with
DRG therapy in 10 patients. Patient-reported outcome measures were collected
pre-trial, post-trial, and post-device implantation, to determine the
efficacy of DRG. We hypothesized that DRG stimulation would demonstrate a
meaningful change in PROMIS-29 domains and at least 50% improvement in pain
intensity at 8 wks. Results: All patients
demonstrated a > 5 point change in T scores in PROMIS-29 domains
suggesting a meaningful benefit. Patients also demonstrated a percentage
pain improvement at 8 wks of 64 % based on a numerical rating scale. No
major complications were observed. Conclusions: DRG
stimulation is a safe and effective treatment option for neuropathic
pain.
P.155 Prospective cohort analysis of normal versus mild cognitive
impairment for quality of life outcome following DBS for Parkinson’s
disease
Authors: Honey C , Almeida T , Honey CR
Published: January 2022

Background: All guidelines for DBS in Parkinson’s
disease (PD) include a contraindication for ‘dementia’. It is unclear where
this cut-off should occur and if patients with mild cognitive impairment
(MCI) do not do as well. This prospective cohort analysis assessed if
pre-operative cognition affected post-operative quality of life.
Methods: PD patients receiving bilateral STN-DBS
(n=100) were prospectively studied using STROBE guidelines. All had Montreal
Cognitive Assessment (MoCA), motor (UPDRS), mood (BDI-II), and quality of
life (Parkinson Disease Questionnaire summary index, PDQ-39-SI). Two
cohorts, pre-operative MCI (MoCA:18-25) and normal cognition (MoCA:26-30),
had post-operative PDQ-39-SI at 1-year. The primary outcome was the
proportion of patients with an improved PDQ-39-SI at 1-year.
Results: Cohorts were not significantly different
in age, severity of illness, response to dopamine, or mood. MCI was present
in 27/100. Improved quality of life at 1-year occurred in 75% with normal
cognition and 70% with MCI (p=0.54) with RR=1.1 (95% CI, 0.8-1.5). Linear
regression analysis showed no correlation between pre-operative cognition
and post-operative outcome (R2=0.02).
Conclusions: Parkinson’s patients with MCI should
be offered DBS if their motor symptoms require surgery. Guidelines for DBS
surgery in PD should change from “dementia is contraindicated” to “patients
require adequate cognitive functioning, MoCA318”.
P.156 Outcomes of Cranial Nerve Deficits in Patients with Pituitary
Apoplexy: The Ottawa Hospital Experience
Authors: Alahmari M , Kilty S , Lasso A , Banaz F , Mohajeri S , Masoudian P , Lamothe A , Agbi C , Caully L , Alshardan M , Alkherayf F
Published: January 2022

Background: One of the rare but urgent
presentations of a pituitary tumor is pituitary apoplexy. In this case
series, we describe our experience regarding the cranial nerve recovery in
patients with pituitary apoplexy following endoscopic endonasal
transsphenoidal surgery (EETS). Methods:
Retrospective cohort study with patient characteristics, tumor type,
endocrine data, operation data collected. Postoperative data were extracted
for the follow-up period available for each patient.
Results: 15 pituitary apoplexy cases were
identified. The cranial nerve deficits presented at admission were: visual
deficit (33% patients); unilateral third nerve palsy (47% patients),
unilateral sixth nerve palsy (27% patients). Postoperatively, 60% of
patients with preoperative visual deficit had normal visual fields and the
other 40% showed improvement. From those with oculomotor nerve dysfunction
preoperatively, 43% have returned to normal nerve function and 57% presented
improvement. 75% cases of abducens nerve palsy resolved postoperatively,
while 25% showed improvement. Conclusions: Based on
this series, surgical treatment should be offered to patients presenting
with cranial nerve deficit in the setting of pituitary apoplexy. In this
series, all cranial nerve deficits either returned to normal or improved
following surgery. Though a small series, the presented results are superior
to those reported in the literature for conservative management.
P.162 Effects of Systemic Corticosteroid Treatment on Pseudotumoral
Hemicerebellitis
Authors: Vivekanandan A , Santyr B , Ranger A
Published: January 2022

Background: Pseudotumoral hemicerebellitis is an
acute, unilateral inflammation of the cerebellum that typically affects the
pediatric population. The etiology remains to be elucidated, however
frequently is attributed to post-infectious inflammation. Though it tends to
be self-resolving, treatment may reduce the time to symptomatic recovery.
Systemic corticosteroid therapy has been proposed as a mechanism for
improving outcomes and time to symptomatic recovery.
Methods: We present a case report of a
12-year-old male with pseudotumoral hemicerebellitis and unilateral
cerebellar dysfunction. Additionally, we briefly review the additional 35
reported cases of pseudotumoural hemicerebellitis with respect to length of
time to symptomatic recovery with or without systemic corticosteroid
treatment. Results: 30 cases reported length of time
to symptomatic recovery. Including our case, the mean time to recovery for
those treated with systemic corticosteroids (n=20) was 48.05 days(SE=16.3).
The mean time to recovery for those treated without (n=10) was 86.7
days(SE=29.3). Conclusions: Treatment with systemic
corticosteroids was associated with a faster time to symptomatic recovery
compared to without. Regardless of etiology, reducing inflammation and mass
effect involved in pseudotumoral hemicerebellitis may be integral to a more
rapid return to neurological baseline.
P.166 Assessment of External Ventricular Catheter Associated Infections
at the Ottawa Hospital: Literature Review and Quality Improvement
Initiative
Authors: Ben Nakhi S , Drake B , English S
Published: January 2022

Background: External ventricular drains are a
lifesaving intervention in the management of acute hydrocephalus. EVD
associated infections vary significantly, and expert panels recommend
reviewing institutional policies if infection rates exceed 10%. The audit
aims to identify the infection rate at our institution, whereas the
literature review aims to synthesize a new institutional EVD best practice
guideline. Methods: An audit of EVD catheters
inserted in the time period between 07/01/2019 and 10/25/2020 was conducted.
Statistical analysis to calculate absolute incidence, infections per 1000
days of catheter use. A literature review to identify best practices for the
insertion and management of EVDs was conducted.
Results: 75 patients required a total of 105 EVD
catheters. There were 16 (15.3%) EVD related infections, equating to 14.3
infections per 1000 days. Fifty percent of patients developed an EVD related
infection within 9 days of insertion. Most infections were induced by skin
flora (87.5%). A comprehensive step-by-step EVD insertion and management
protocol was developed aiming to reduce the risk of infection.
Conclusions: The incidence of EVD associated
infections at the Ottawa Hospital is significantly higher than acceptable
rates as suggested by expert panels. A new evidence-based best practice
guidelines should be implemented. A follow-up audit is necessary.
P.176 Assessing the competence of neurology residents in performing an
interphysician telephone consultation.
Authors: Florendo-Cumbermack AG , Jenkins ME , Chahine S , Vennance S , Yiu-Chia C
Published: January 2022

Background: Neurology Residency training in
Canada is transitioning to competence based medical education (CBME) in July
2020 and the Royal College Neurology Specialty Committee has identified
“providing consultation for and managing patients at outlying centers,” to
be an entrustable professional activity (EPA). At Western, neurology
telephone consultations, from outlying centres, are attended by both the
resident and the staff Neurologist. This scenario provides the ideal
situation for direct observation and immediate formative feedback. The
resident’s performance is assessed using the ’TeleTool’ which utilizes an
entrustment scale and has a short narrative portion.
Methods: This mixed methods study aims to
determine the reliability and validity of the ’TeleTool’ in assessing the
performance of the telephone consultation by senior neurology residents.
Informed consent was obtained from residents (9) and staff (7) involved.
Scores on the entrustment scale and narrative comments were analysed.
Results: Information on 30 encounters (involving
9 residents) was collected. TeleTool results demonstrated higher entrustment
scores in PGY4 and PGY5 levels. Overall, ratings were consistent across the
7 consultants assessors. Conclusions: The TeleTool
was reliable and valid in assessing competence in the telephone consultation
and will be a useful tool for assessment of this EPA.
P.188 Neurotrauma in Indigenous populations of Canada: challenges and
future directions: A Scoping Review
Authors: Salaheen Z , Moghaddamjou A , Fehlings MG
Published: January 2022

Background: Neurotrauma accounts for over 24 000
hospitalizations annually in Canada. Among those affected, Indigenous
peoples are disproportionately impacted. The goal of this scoping review is
to identify factors underlying these disparities.
Methods: A scoping review was conducted to
collect papers pertaining to neurotrauma in Indigenous populations of
Canada. Using MEDLINE, 676 articles were screened with MeSH terms including
‘Indigenous’, ‘spinal cord injuries’, ‘brain injuries, traumatic’ and
‘Canada’ as of April 2021. Results: Studies report
over twice the incidence of traumatic brain injury and traumatic spinal cord
injury in Indigenous populations compared to non-Indigenous populations. The
burden of neurotrauma is attributable to infrastructure disparities in rural
communities and reserves, elevated rates of substance use and violence, and
inequities in treatment and rehabilitation following injury. These issues
are deeply rooted in the trauma endured by Indigenous peoples through the
course of Canadian history, owing to government policies that severely
impacted their socioeconomic conditions, culture, and access to healthcare
services. Conclusions: Systems-level interventions
guided by Indigenous community members will help to address the disparities
that Indigenous peoples face in the care and rehabilitation of neurotrauma.
This study will inform further research of culturally appropriate approaches
to reduce neurotrauma burden among Indigenous peoples.
P.191 Development and Testing of a Novel Hydrogel Embolization Treatment
for Neurovascular Diseases: Preliminary Animal Results
Authors: Ku JC , Dobashi Y , Pasarikovski CR , Ramjist J , Madden J , Walus K , Yang V
Published: January 2022

Background: Embolization represents a minimally
invasive treatment modality for arteriovenous malformations (AVMs), tumors,
aneurysms, and vessel sacrifice, but can be limited by currently available
embolization agents. Discovery of new and improved agents could lead to
better treatment outcomes. The goal of this project was to develop and test
a novel embolization agent using hydrogels, a class of materials which may
be bioengineered to suit a variety of indications.
Methods: We devised a method of liquid hydrogel
embolization with photo-modulated crosslinking for intravascular
solidification, using a custom microcatheter set-up. We tested this in swine
blood vessels (n=3), the swine renal arterial trees as a vascular tumor
model (n=5), and the swine arterial-arterial networks of the rete mirabile
as an AVM model (n=3). Hydrogel embolization was assessed for treatment
efficacy and safety. Follow-up angiography was performed at 2-4 week
intervals. Results: Hydrogel embolization was
technically successful in all animals, with full occlusion of the vascular
target immediately following embolization and at follow-up. There were no
instances of clinical or angiographic complications.
Conclusions: We demonstrated a novel method of
dynamic photomodulation and delivery of bioengineered hydrogels to address
current limitations of endovascular embolization therapies. This promising
technology will be investigated further with longer-term comparative animal
trials.
P.224 A Case Report of Spinal Screws Penetrating the Pulmonary
Artery
Authors: Girgis H , Mulder D
Published: January 2022

Background: Spinal instrumentation is commonly
utilized to mechanically stabilize the spine in trauma, oncology and
degenerative disease. Although several complications have been reported,
this is the first case of screw penetration of the pulmonary artery.
Methods: We present a case of a 74-year old
gentleman who suffered from a thoracic spine chordoma. He underwent a T8
resection with T8-T12 instrumented fusion with subsequent radiation.
Recurrence of his disease led to resection of his 3rd
and 4th ribs and repeat radiation. He presented 6 years
later with 2 episodes of massive hemoptysis. Review of the literature was
conducted to search for similar complications.
Results: A Chest Computed Tomography scan
demonstrated the presence of a pedicle screw tip in the right pulmonary
artery. Angiogram revealed no evidence of active arterial extravasation. In
the operating room, the patient had a right lower lobectomy, with segmental
pulmonary artery sacrifice, as well as replacement of the spinal fixation
hardware. Literature review revealed multiple aortic injuries following
spinal instrumentation. However, this was the first case of pulmonary artery
erosion. Conclusions: Spinal instrumentation has been
associated with screw migration and penetration of nearby tissues and
vessels. A high incidence of suspicion is required when patients present
with delayed and unusual complications.
P.205 Association Between Vein of Galen Aneurysmal Malformation and
Hirayama Disease: A Clue into Pathophysiology?
Authors: Ashour M , Fortin O , Sébire G , Saint-Martin C , Poulin C , Dudley R
Published: January 2022

Background: Hirayama Disease (HD) is a rare
disorder consisting of insidious onset of unilateral weakness and atrophy of
the forearm and intrinsic hand muscles. Vein of Galen aneurysmal
malformations (VGAMs) are rare congenital cerebral vascular malformations,
consisting of high-flow arteriovenous shunting between a persistent median
prosencephalic vein and arterial feeders. Methods: 14
years old boy known for VGAM presented with left-sided HD. His cervical MRI
revealed enlarged epidural with anterior, left-ward displacement of the
posterior dura and spinal cord. He underwent surgical treatment by
laminotomies, along with tenting of an autologous duroplasty to the
overlying laminae. Results: We decided to combine
epidural venous plexus coagulation with posterior duraplasty and dural
fixation using tenting suture which led to a favorable clinical outcome has
not been previously proposed in the literature.

We hypothesize that in this context, an abnormal vasculature could also
predispose to posterior epidural venous plexus engorgement, anterior dural
displacement in cervical flexion, and microvascular changes in the anterior
spinal arterial circulation, leading to the progressive anterior horn cell
ischemia that lead to the clinical phenotype of HD.
Conclusions: The association between HD and VGAM
in this patient may provide clues with regard to the pathophysiology of
HD.
P.211 Characterizing and comparing brain injury associated with
traditional self-retracting brain retractors with novel tubular
retractors
Authors: Naeem A , Dryden G , Hammond R , Speechley M , Wade K , Boulton M
Published: January 2022

Background: Tubular retractors are FDA approved
and in the Neurosurgical marketplace, but adaptation has been hampered by
lack of evidence showing superiority over traditional retractors when
performing subcortical surgery. This study examines brain injury associated
with traditional brain retractors versus tubular retractors.
Methods: Nine porcine models underwent a
simulated neurosurgical operation. Retractors were inserted for four hours
after which the porcine model was euthanized. The en-bloc extracted porcine
brain was fixed in 10% formalin, paraffin embedded, sectioned at 4 um and
stained with hematoxylin and eosin (H&E) using standard laboratory
protocols. Computer algorithms were generated to calculate areas of cerebral
edema and hemorrhage adjacent to retractor surfaces.
Results: Using a two-tailed t-test with a
significance level of 0.05, traditional brain retractors were associated
with statistically significant greater areas of cerebral edema when compared
to tubular retractors (17.36 um2 vs. 12.42
um2; p = 0.0038). There was no statistically
significant difference in mean areas of hemorrhage between traditional brain
retractors and tubular retractors (3.43 um2 vs 3.60
um2; p = 0.8297).
Conclusions: Tubular retractors are associated
with significantly less edema in surrounding brain than traditional
retractors. On histopathological merits, this study supports the application
of tubular retractors over traditional retractors.