bluuebunny/crossref_metadata_2025 huggingface dataset:
P.076 Epidemiology of traumatic spinal cord injury patients in New Brunswick
Authors: Chishti YZ , Gaudet D , O’Connell C , Attabib N
Published: June 2016

Background: Characteristics of traumatic spinal cord injury (tSCI) patients admitted to the Saint John Regional Hospital and the Stan Cassidy Center for Rehabilitation from 2011 to 2014 were examined. Methods: Demographic, neurological and functional outcome data for 18 patients, who had consented to participate in a database for tSCI in Canada, was obtained. Results: The majority of patients were male (88.9%), with a mean age of 41. 33 (SD=17.17). The most common causes of tSCI were motor vehicle accidents (41.2%) and falls (29.4%). Cervical spine injuries (70.6%) and an ASIA impairment scale classification of D (38.9%) predominated. The median latency from injury to surgery was 22.67 hours. Functional independence Measure scores (M=64.17, SD=25.84) indicated that motor/functional independence was impaired (M=32.44, SD=19.15) relative to cognitive independence (M=31.83, SD=4.07). Conclusions: The results suggest that characteristics of tSCI patients in New Brunswick are similar to the Canadian tSCI patient population. Emergency care appears to be delivered in a timely fashion. Both centers participate in research registries focused on collecting data related to tSCI, surgical interventions, and patient outcomes. Registries are valuable research tools that allow for an alternative way to examine the quality of care their patients receive.
P.077 A Concussion-U educational presentation improves knowledge and attitudes of concussion amongst elite female high-school hockey players
Authors: Eagles M , Powell M , Bradbury-Squires D , Murphy J , Campbell G , Fletcher J , Maroun F
Published: June 2016

Background: Research has suggested that female athletes have a higher incidence of concussion compared to their male counterparts. As such, programs designed to improve knowledge and attitudes of concussion should target this high-risk population. Previous work demonstrated the effect of a novel Concussion-U educational presentation on knowledge and attitudes of concussion amongst male Bantam and Midget AAA hockey players. The objective of this study was to determine if the same presentation was effective in improving the knowledge and attitudes of concussion in a cohort of elite female hockey players. Methods: 26 elite female high-school aged (14-17) hockey players from the province of New Brunswick consented to participate in the study. Each participant completed a modified version of Rosenbaum and Arnett’s Concussion Knowledge and Attitudes Survey questionnaire immediately before and after a Concussion-U educational presentation. Results were compared across the two time-points to assess the effectiveness of the presentation. Results: Concussion knowledge and attitude scores significantly (p<.001) increased from pre-presentation to post-presentation by 12.5% and 13.4%, respectively. Conclusions: A Concussion-U educational presentation resulted in increased knowledge and improved attitudes towards concussion in elite female hockey players. Future research should examine the long-term retention of these improvements.
P.090 A systematic review of the risks and benefits of venous thromboembolism prophylaxis in traumatic brain injury
Authors: Dandurand C , Margolick J , Evans D , Sekhon M , Garraway N , Greisdale D , Gooderham P , Hameed MS
Published: June 2016

Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of chemoprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the post-injury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were: studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers based on levels of evidence. Results: A total of 408 studies were screened. Forty-five studies were reviewed in-entirety and 21 were included in the systematic review. There were 2 prospective randomized trials and 19 comparative studies. Eighteen total studies demonstrated that VTEp post injury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration specifically 24–72 hours post injury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive ICH. Conclusions: Literature suggests that administering VTEp 48 hours post-injury may be safe for patients with low-hemorrhagic risk TBIs and stable injury on repeat imaging.
P.094 Modified Obwegeser temporal approach to the infratemporal fossa: four cases and review of literature
Authors: Wang BH , Woodford R , Armstrong J , Lownie SP
Published: June 2016

Background: The infratemporal fossa is an anatomically complex region. Lesions that arise in the infratemporal fossa are uncommon; however, their surgical resection remain challenging. Here we present a modified preauricular subtemporal approach initially described by Obwegeser et al. used in four patients with large skull base lesions. Methods: Retrospective case series of 4 patients Results: Four patients with various lesions of the infratemporal fossa (aneurysmal bone cyst, giant cell tumor of the bone, recurrent melanoma and recurrent clival chordoma) underwent surgical resection using the modified Obwegeser approach. A multidisciplinary team cared for patients consisting of maxillofacial surgery, otolaryngology and neurosurgery. After either nasotracheal intubation or tracheostomy, the patient’s jaw was temporarily wired shut. A curvilinear incision was fashioned and the root of zygoma was exposed (masseter attached) and osteotomized followed by inferior mobilization. The mandibular condyle is osteomized next and TMJ disarticulated with temporalis muscle still attached and reflected superiorly. Surgical resection of tumor then proceeded centered around the region bridging the temporal and infratemporal fossae. Reconstruction was carried out using plates and screws. Conclusions: The modified Obwegeser approach can provide safe and direct access to certain infratemporal fossa lesions with good cosmesis and functional outcome for patients without substantially increasing OR time.
P.098 Arterial wall and plaque remodeling after stent deployment in carotid stenosis: ultrasonographic study
Authors: Martinez-Perez R , Marchuk G , Lee D , Pelz D , Lownie S
Published: June 2016

Background: We evaluated the effects of stents on carotid plaque and the arterial wall using carotid ultrasound in carotid stenting patients Methods: From a carotid stent database, 30 consecutive patients were selected. All had Doppler ultrasound performed pre and post-stenting. The diameters of the lumen at the level of stenotic plaque pre and post stenting, the dorsal and ventral plaque thickness, and of the outer arterial wall diameter were measured. Plaque thickness was measured at the level of maximal stenosis.Non parametric tests were used to determine whether the stent effect and luminal enlargement were based on wall remodeling or on total arterial expansion. Results: Patient was followed for an average of 22 months. 18 patients were male, average age 70 years. 87% were symptomatic ipsilateral to the side of stenosis. The luminal diameter increased post stenting in the region of severe stenosis. Plaque thickness, both ventrally, as well as dorsally decreased post stenting, with no significant difference between the ventral and dorsal plaque effects. The measured lumen in the stent increased over time post-stenting. Conclusions: Self-expanding nitinol stents alter the baseline ventral and dorsal plaque to a significant degree, and do not significantly affect the native arterial wall and the overall arterial diameter.
P.108 Diffuse large B-cell Lymphoma secondary to iatrogenic immunosuppression with unusual MRI findings and literature review
Authors: Naeem AH , Staudt MD , Wang B , Lee D , Parrent A
Published: June 2016

Background: Immunosuppressive therapy is a risk factor for lymphoproliferative disorders. We present a case of primary CNS B-cell lymphoma in the setting of iatrogenic immunosuppression from azathioprine usage. A literature review is provided. Methods: Case report Results: 64-year-old male presents with several weeks of cognitive decline, impaired speech, and headache with a history of ulcerative colitis (on azathioprine and 5-ASA) with no radiological evidence of systemic malignancy. MR showed left frontal extra-axial mass (4.0 x 2.4 x 4.0 cm) with heterogeneous enhancement of a solid component with local dural thickening. The enhancing mass had solid and cystic components. Radiological differential included dural metastasis, atypical meningioma or unusual intra-axial mass including GBM with some dural involvement. He underwent surgical resection, which showed a primary CNS lymphoma, diffuse large B-cell, CD 20 + and EBV +. Post-operatively his cognition improved. Azathioprine was stopped and 5-ASA was increased. He proceeded with MPVC (methotrexate, procarbazine, vincristine, and cytarabine) chemotherapy. Conclusions: Our case shows isolated extra-nodal CNS manifestation of lymphoma in the context of immunosuppressive medications with strikingly atypical MR findings leading to a pre-operative diagnostic dilemma. Treatment is challenging and needs to be individually tailored due to a need for stopping immunosuppressive agents in conjunction with CNS lymphoma treatment.
P.109 Increased survival when combining BRAF inhibitors and stereotactic radiosurgery in patients with melanoma brain metastases
Authors: Wolf A , Pavlick A , Wilson M , Silverman J , Kondziolka D
Published: June 2016

Background: The purpose of the study was to evaluate the impact of BRAF inhibitors on survival outcomes in patients receiving stereotactic radiosurgery (SRS) for melanoma brain metastases. Methods: We prospectively collected treatment outcomes for 80 patients with melanoma brain metastases who underwent SRS. Thirty-five patients harbored the BRAF mutation (BRAF-M) and 45 patients did not (BRAF-WT). Results: The median overall survival from first SRS procedure was 11.2 months if treated with a BRAF inhibitor and 4.5 months for BRAF-WT. Actuarial survival rates for BRAF-M patients on an inhibitor were 54% and 41% at 6 and 12 months after radiosurgery, in contrast to 28% and 19% for BRAF-WT. Overall survival was extended for patients on a BRAF inhibitor if initiated at or after the first SRS. The local control rate did not differ based on BRAF status and was over 90%. Patients with higher KPS, fewer treated metastases, controlled systemic disease, RPA class 1 and BRAF-M patients had extended overall survival. Conclusions: Patients with BRAF-M treated with both SRS and BRAF inhibitors, at or after SRS, have increased overall survival. As patients live longer due to more effective systemic and local therapies, close surveillance and early management of intracranial disease with SRS will become increasingly important.
P.111 Large partially thrombosed posterior circulation aneurysms: A treacherous masquerader of benign brain tumors
Authors: Alizadeh Vakili N , Chiu A , Drake B , Montanera W , Bharatha A , Marotta T , Sarma D , Spears J
Published: June 2016

Background: On imaging, thrombosed aneurysms can be mistaken for tumor with potentially disastrous consequences. Methods: We present two cases of aneurysms mimicking tumor. Results:Patient 1 (6 months of left-sided facial weakness): MRI demonstrated a 3.3 cm, T1-isotense, T2-hypertense heterogeneous enhancing mass favored to represent a CPA schwannoma. Biopsy revealed a thrombosed aneurysm. DSA subsequently revealed an area of contrast penetration, treated by parent artery (AICA) obliteration. Two-year follow-up revealed stable occlusion with reduced mass effect. Patient 2 (1 year of headaches): Imaging demonstrated an extra-axial T1-mixed, T2-hyperintense heterogeneously enhancing mass in the left CPA adjacent to the vertebral artery, enlarging from 1.7 cm to 3.2 cm over 2 years. DSA revealed slow, crescentic filling with suggestion of arborisation distally. Patient deteriorated due to mass effect requiring a VP shunt and passed away from SAH 3 months later. Imaging review revealed crescentic filling of the remnant lumen on CE-MRA and signal voids on T2 in both cases, which may suggest the aneurysm diagnosis. However our cases did not have other features such as lamellated thrombus or pulsation artifact. Conclusions: Central contrast enhancement does not necessarily preclude the diagnosis of thrombosed aneurysm. The possibility of revascularization or penetration of contrast through the thrombus in giant aneurysms needs to be considered.
P.119 Minimally invasive surgical disconnection of a spinal dural arteriovenous fistula with the use of intraoperative digital subtraction angiography
Authors: Staudt MD , Wang B , Lownie SP
Published: June 2016

Background: Spinal dural arteriovenous fistulas (dAVF) are a significant but treatable cause of progressive myelopathy. The goal of treatment is disconnection of the fistula, which is often accomplished through an open surgical approach. We report two cases using a minimally invasive surgical (MIS) approach for dAVF ligation with intraoperative digital subtraction angiography (DSA) to confirm occlusion. Methods: Case report. Results: Two patients presented with progressive thoracic myelopathy and were identified to have fistulous connections at the left L1 and T8 levels respectively. Intraoperatively, a left femoral puncture was performed and a 5-French (40 cm) sheath was inserted. Patients were positioned prone and intraoperative spinal DSA was performed using the Siemens Zeego. Once the feeding radicular artery was visualized, image overlay and cross-hair laser was used to trace and localize the fistulous zone. A unilateral single level MIS hemi-laminectomy was performed. The fistulous zone and accompanying nerve root were exposed and small hemostatic clips were applied followed by surgically disconnection. Finally, intraoperatively video angiography as well as spinal DSA were performed for confirmation. Conclusions: MIS disconnection with intraoperative DSA is a safe and effective technique for treating spinal dAVFs. Patients benefit from quicker recovery and shorter hospital stay.
P.124 Meta-analysis comparing predictors of good postoperative seizure control in children with dysembryoplastic neuroepithelial tumors and gangliogliomas
Authors: Ranger A , Diosy D
Published: June 2016

Background: Dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas are the most common cause of tumor-related seizures in children and adolescents. Little is known about predictors of surgical success, in terms of seizure freedom. All relevant papers since 1995 were identified. Methods: Over 4000 abstracts were screened on MedLine to identify data comparing tumor type (DNET vs. ganglioglioma) and predictors of post-operative seizure freedom. Results: Seventeen papers were identified encompassing 97 DNET and 95 ganglioglioma patients. Fifteen patients were found with other neuroglial tumors (NGT) or NGT not-otherwise-specified. DNET patients were found to have less frequent seizures, more likely to have second lobe involvement, and to achieve gross total resection. Seizure freedom was achieved in roughly 80% of patients, with no distinction by tumor type, with no surgery-related or peri-operative deaths. For DNETs, seizure freedom was associated with shorter seizure duration, simple lesionectomy, gross total resection, and shorter duration of follow-up. In ganglioglioma patients, seizure freedom was associated with younger age at surgery, secondary generalization (unexpectedly), absence of dysplasia, and gross total resection. Gross total resection was the strongest predictor. Conclusions: Epilepsy surgery for DNET and ganglioglioma had similar outcomes with gross total resection being the strongest predictor.
P.127 Management and outcome of spontaneous sub-aponeurotic fluid collections in infants: the Hospital for Sick Children experience and review of literature
Authors: Wang S , Kulkarni AV , Drake J
Published: June 2016

Background: Spontaneous sub-aponeurotic fluid collection (SSFC) is an uncommon and newly described entity of unknown etiology, observed in infants less than one year of age. In this paper, we report a series of 9 infants who presented to the Hospital for Sick Children with SSFC over the 2004 to 2015 period, focusing on the natural history of this rare condition. Methods: Data from the HSC was retrospectively reviewed. Patient age and gender, birth history, past medical history, laboratory findings, imaging characteristics, management, and outcome were analyzed. Results: Our case series consists of 4 males and 5 females, ranging from 5 weeks to 11 months of age. All cases of SSFC developed spontaneously over a period of days, and the infants had no history of injuries or hair manipulation. Six patients had a remote history of forceps or vacuum-assisted births. One patient experienced fluctuating fluid collection size over 4 months, but in all the cases, the collections resolved spontaneously without structural or infectious complications. Conclusions: This is the largest series describing SSFC to date, and summarizes the experience of a large academic neurosurgical center. SSFCs develop spontaneously without immediate preceding trauma, and an extensive hematology or child abuse workup is not necessary. A conservative approach with outpatient follow-up is advocated.
P.128 The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spinal metastatic disease
Authors: Dakson A , Leck E , Butler M , Thibault-Halman G , Christie S
Published: June 2016

Background: The Spinal Instability Neoplastic Score (SINS) is used to assess mechanical instability based on radiographic and clinical factors. We conducted this study to evaluate the clinical utility of SINS in surgical decision-making in spinal metastasis and its association with metastatic epidural spinal cord compression (MESCC). Methods: We allocated 285 patients with spinal metastatic disease through a retrospective review. SINS was calculated using good-quality computed tomography. The degree of MESCC was assessed using 0 to 3 grading system. Results: Based on SINS, patients were categorized into stable (35.1%), potentially unstable (52.3%) and unstable (12.6%) groups. In the surgical intervention group, there was 69.5% treated with decompression and instrumented fusion, 17% with decompression alone, 8.5% with percutaneous vertebral augmentation and 5% with instrumented vertebral augmentation. A significantly higher proportion of patients with stable SINS (63.6%) were treated surgically without instrumentation (X2=10.6, P=0.005), whereas instrumentation was utilized in 87.5% of patients with unstable SINS. Grade 3 MESCC occurred in 65.5% of patients with unstable SINS, whereas 71.4% of patients with stable SINS had grade 0 MESCC (X2=42.1, P<0.001). Conclusions: SINS is associated with higher degrees of MESCC and plays an important role in surgical decision-making, facilitating assessment and recognition of spinal instability in need of urgent appropriate surgical interventions.
P.129 Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumor histology
Authors: Dakson A , Leck E , Butler M , Thibault-Halman G , Christie S
Published: June 2016

Background: This study aims to provide epidemiological data concerning spinal instability and patterns of metastatic invasion of the spine based on tumor histology. Methods: We allocated 285 patients with spinal metastatic disease through a retrospective review. SINS was calculated using good-quality computed tomography (CT) imaging studies. Spinal metastases were also grouped into intracompartmental, extracompartmental or multiple metastases. Results: Esophageal cancer was the least likely to be associated with instability with about 64% of cases being stable. The highest rate of instability scores was observed in breast carcinoma with 18% of cases graded as unstable. Renal cell carcinoma was associated with lytic spinal metastases whereas blastic metastases mostly occurred in prostate carcinoma (P<0.001). Whereas 68.1% of cases represented multiple metastases, the remainder was associated with either intracompartmental (13.3%) or extracompartmental (18.6%) disease. The highest degrees of spinal instability (intermediate and unstable categories) were associated with extra-compartmental metastatic disease (P<0.001). Conclusions: This study sheds light on the patterns of spinal metastatic disease and mechanical instability on the basis of tumor histology, utilizing standardized scoring systems. The utilization of such scoring systems allows for a standardized approach towards description and analysis of spinal metastasis facilitating clinical research in this avenue.
P.131 Lumbar fusion for degenerative disease: a systematic review and meta-analysis
Authors: Yavin D , Isaacs AM , Casha S , Wiebe S , Feasby TE , Atta C , Holroyd-Leduc J , Hurlbert RJ , Quan H , Nataraj A , Sutherland GR , Jette N
Published: June 2016

Background: Lumbar fusion for degenerative indications is associated with a great degree of practice variation. We summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression alone, or non-operative care for degenerative indications. Methods: Literature search of electronic bibliographic databases was conducted. Comparative studies reporting validated measures of safety or efficacy were included. Treatments effects were calculated through DerSimonian and Laird random effects models. Results: We retrieved 62 studies (17 randomized controlled, 15 prospective, 15 retrospective, and 15 registries), enrolling a total 302,347 adult patients. Disability, pain, and patient satisfaction following fusion, decompression alone, or non-operative care were dependent on surgical indications and study methodology. Relative to decompression alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% CI 1.06 to 1.30, p<0.004) and decreased for spondylolisthesis (RR 0.71, 95% CI 0.59 to 0.84, p<0.001). In all indications, complications were more frequent following fusion (RR 1.88, 95% CI 1.37 to 2.58, p<0.001). Mortality and treatment modality were not associated. Conclusions: Improvements were greatest in patients undergoing fusion for spondylolisthesis while complications limited the role of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggested careful patient selection is required.
P.132 Post-traumatic spinal pseudomeningocele with delayed neurological deterioration
Authors: Karapetyan VA , Staudt MD , Shettar BC , Faizal HA , Wai NP
Published: June 2016

Background: Post-traumatic spinal pseudomeningoceles are uncommon sequelae of brachial plexus injuries. These cerebrospinal fluid (CSF) collections have rarely been described to occur within the spinal canal with resultant cord compression and neurological deficit. We present the case of an intracanalicular pseudomeningocele causing spinal cord compression and progressive radiculomyelopathic weakness more than a decade after the original injury. Methods: Case report and review of the literature. Results: A 34 year old man presented with progressive cervical radiculomyelopathy 16 years after sustaining a brachial plexus avulsion injury. Magnetic resonance imaging revealed an anterior epidural intracanalicular fluid collection from C3 to L3, with focal compression at the cervicothoracic junction. Surgical intervention involved a C7 to T3 laminectomy and fenestration of the anterior dura to permit communication of CSF between the dural space and pseudomeningocele. His strength and dexterity improved dramatically post-operatively. Conclusions: Spinal pseudomeningoceles following a traumatic brachial avulsion injury are typically found outside the spinal canal and are usually not associated with any neurological symptoms. There are few reported cases of post-avulsion intracanalicular pseudomeningoceles which present with delayed spinal cord compression and neurological dysfunction. Therefore, patients with a history of a traumatic avulsion injury and delayed neurological symptoms should warrant additional investigations.
P.136 Type III odontoid fracture with C1 and C2 distraction injury manifesting as a variant of occipital-cervical dissociation
Authors: Naeem AH , Alrumaihi G , Bailey C
Published: June 2016

Background: Isolated odontoid type III fractures are usually stable with surgical fixation reserved for significant fracture displacement or inability to maintain alignment with external immobilization. We present a rare but important pattern of injury involving a C2 fracture with C1 and C2 distraction behaving as a variant of occipital-cervical dissociation. Methods: Case Report Results: An 88-year-old female was involved in a motor vehicle accident and was transferred to a trauma centre from a peripheral hospital intubated. She was diagnosed with a significant injury to the C2 vertebral body with distraction between C1 and C2, which is a variant of an occipital-cervical dissociation. This patient had significant facial injuries, a zygomatic fracture, multiple lacerations, and a pulmonary contusion. Her ISS (Injury Severity Score) was greater than 16. She was however from a spine perspective neurologically intact. She required stabilization in the form of an occiput-cervical fusion. Conclusions: We present a polytrauma patient with a C2 distraction type injury and atlantoaxial dissociation manifesting more like an occipital-cervical dissociation injury with very good pre-operative imaging. These injury patterns are critical to recognize as they are unstable requiring occiput-cervical fusion instead of a cervical fusion alone which is reserved for some cases of odontoid Type III fractures.
A.04 Anatomic variation of the Circle of Willis in perinatal stroke
Authors: de Jesus PN , Mineyko A , Kirton A , Yu S
Published: June 2016

Background: Perinatal stroke is a common disorder in neonates with unknown etiology. Previous studies have linked anatomic variations in the Circle of Willis to adult stroke. This study aimed to understand the potential relationship between circle anatomy and common forms of perinatal stroke: NAIS, APPIS, and PVI. Methods: 94 subjects (62 NAIS/APPIS, and 32 PVI) were identified from the Alberta Perinatal Stroke Project. Inclusion criteria were: MRI-confirmed perinatal stroke, 3D-TOF MRA, and absence of other disorders. Images were classified as complete, incomplete posterior circulation, incomplete anterior circulation, and incomplete anterior and posterior circulation. Fisher Exact Test compared completeness against stroke type and segment absence ipsilateral to stroke. Mann-Whitney U compared completeness and lesion volume. Results: Completeness was more common in PVI than NAIS/APPIS (p=0.500) and in healthy controls than total stroke population (p=0.251). Ipsilesional absent segments were more frequent in NAIS/APPIS (p= 0.270). NAIS/APPIS patients with complete CoW had larger median lesion volume was compared to those with incomplete circles (p=0.484), with contralateral absence (p=0.943), and with ipsilateral absence (p=1.00). The opposite was found in PVI patients for all lesion volume comparisons (p=0.321, 0.362, 0.739 respectively). Conclusions: Circle anatomy is highly variable in perinatal stroke. Absence of segments is not associated with stroke type, lesion side, and lesion volume.
A.06 Ataluren: an overview of clinical trial results in nonsense mutation Duchenne Muscular Dystrophy (nmDMD)
Authors: McDonald CM , Bushby K , Tulinius M , Finkel R , Topaloglu H , Day JW , Flanigan K , Lowes L , Eagle M , Luo X , Elfring G , Kroger H , Riebling P , Ong T , Spiegel R , Peltz SW
Published: June 2016

Background: Ataluren is the first drug to treat the underlying cause of nmDMD. Methods: Phase 2 and 3 studies of ataluren in nmDMD were reviewed, with efficacy and safety/tolerability findings summarized. Results: Ataluren nmDMD trials include: a Phase 2a proof-of-concept study (N=38); a Phase 2b randomized controlled trial (RCT) (N=174); an ongoing US-based open-label safety extension study (N=108); an ongoing non-US-based open-label safety/efficacy extension study (N=94); and a Phase 3 RCT, ACT DMD (N=228), whose primary endpoint was change in six-minute walk distance (6MWD) over 48 weeks. The proof-of-concept study demonstrated increased dystrophin production in post-treatment muscle biopsies from ataluren-treated patients with nmDMD. The Phase 2b results demonstrated an ataluren treatment effect in 6MWD, timed function tests, and other measures of physical functioning, The Phase 3 ACT DMD results demonstrated an ataluren treatment effect in patients with nmDMD in both primary and secondary endpoints, particularly in those with a baseline 6MWD of 300-400m. Ataluren was consistently well-tolerated in all three trials, as well as in the ongoing extension studies. Trial findings will be presented in detail. Conclusions: The totality of the results demonstrates that ataluren enables nonsense mutation readthrough in the dystrophin mRNA, producing functional dystrophin and slowing disease progression.

Supported by: PTC Therapeutics Inc.
B.01: Predictors of dysphagia screening after acute ischemic stroke: Who gets tested?
Authors: Joundi RA , Martino R , Saposnik G , Fang J , Giannakeas V , Kapral MK
Published: June 2016

Background: Dysphagia is a devastating complication of stroke and can lead to malnutrition, immobility, aspiration pneumonia, and death. Guidelines advocate screening all patients with acute stroke for swallowing impairment. However, previous research suggests only 60% are screened, and it is unclear what factors contribute to receiving dysphagia screening. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional Stroke Centres from 2010-2013. We used multivariable regression to identify predictors of receiving a dysphagia screen within 72 hours. Results: Among 7172 patients with acute ischemic stroke, 1705 patients (23.8%) did not undergo screening. Factors increasing the odds of being tested were: Stroke unit admission (adjusted odds ratio aOR 6.5), presenting with speech deficits (aOR 1.9) or weakness (aOR 1.5), or receiving thrombolysis (aOR 1.9). Seizure (aOR 0.49) and mild stroke (aOR 0.59 vs moderate stroke) decreased the odds of being tested. Among those with mild strokes who received a swallowing screen, 33% failed. *All p<0.0001. Conclusions: Patients with mild stroke are at risk of not being screened for dysphagia, despite a significant fail rate among those tested. This may expose untested patients to a higher risk of complications from dysphagia, and suggests a gap in process of care that should be addressed.
C.01: Intrathecal morphine following lumbar fusion: a randomized, placebo-controlled trial
Authors: Yavin D , Dhaliwal P , Whittaker T , Hawboldt GS , Jewett GA , Casha S , du Plessis S
Published: June 2016

Background: Despite the ease of intraoperative injection, intrathecal morphine (ITM) is rarely provided in lumbar spine surgery. We therefore sought to demonstrate the safety and efficacy of ITM following lumbar fusion. Methods: In this double-blind trial, 150 patients undergoing elective instrumented lumbar fusion were randomly assigned to receive a single injection of ITM (0.2 mg) or placebo (saline) prior to wound closure. Primary outcomes were postoperative pain on the visual-analog scale during the inital 24 hours after surgery and respiratory depression. Secondary outcomes included related adverse events, opioid requirements, and length of stay. Outcome curves were estimated in an intention-to-treat, repeated-measures analysis. Results: Age, disability, operative times, and pre-operative pain were similar in both groups. ITM was associated with less pain both at rest (p<0.002) and with movement (p<0.02) during the initial 24 hours following surgery. ITM did not increase the cumulative incidence of respiratory depression (hazard ratio 0.86, p=0.66). While ITM reduced postoperative opioid requirements (p<0.03), there was no significant difference in length of stay (p=0.67). Adverse events did not significantly differ between groups. The early benefits of ITM on postoperative pain were no longer apparent after 48 hours. Conclusions: A single ITM injection safety reduces postoperative pain following lumbar fusion. (ClinicalTrials.gov NCT01053039)
D.02 Predictive factors for epilepsy in pediatric patients with Sturge Weber Syndrome
Authors: Kaseka ML , Bitton JY , Major P
Published: June 2016

Background: Sturge Weber Syndrome (SWS) patients at risk of epilepsy are often not identified before their first seizure which leads to unnecessary follow up of many patients with facial angioma. Methods: The medical photography database of our institution has been reviewed to identify SWS patients followed between 1993 and 2013. Patients with isolated glaucoma were compared to patients with epilepsy regarding the location of the facial angioma, the presence of asymmetrical background activity on EEG done prior epilepsy onset and cerebral imaging. Logistical regression tests and a p-value of 0.05 were used. Results: 21 patients with SWS have been identified. No significant difference was noted when patients were compared based on the laterality of the lesion (p=0.169), or the location of the facial angioma (p = 0.314 to 0.999). Only 2 epileptic patients had digital EEG done prior the onset of epilepsy and only 2 patients with glaucoma had digital EEG done during their follow up. No significant difference was noted between EEG background activities in the two groups (p= 0.514). The presence of venous drainage anomalies (VDA) predicted (p = 0.004) the onset of epilepsy. Conclusions: Cerebral VDA increases the risk of epilepsy in SWS patients. Since they can be detected at birth, they might guide the management.
D.05 SREDA-like temporal EEG seizure pattern in LGI1-antibody mediated encephalitis
Authors: Steriade C , Mirsattari S , Murray BJ , Wennberg R
Published: June 2016

Background: Leucine-rich glioma inactived-1 (LGI1) antibodies are associated with limbic encephalitis and distinctive seizure types, which are typically immunotherapy-responsive. While nonspecific EEG abnormalities are commonly seen, specific EEG characteristics are not currently understood to be useful for suspecting the clinical diagnosis. Based on initial observations in two patients, we analyzed the EEG recordings in a larger series of patients and describe a novel ictal pattern that can suggest the diagnosis of LGI1-antibody mediated encephalitis, even in the absence of common clinical features. Methods: Clinical and EEG data were collected in nine patients with LGI1 antibodies. Results: Psychiatric and cognitive symptoms were common, as were tonic seizures associated with EEG electrodecremental events (often with the so-called faciobrachial dystonic semiology). A rarity or absence of interictal epileptiform discharges contrasted with frequent subclinical temporal lobe seizures in some patients, which at times showed characteristics similar to subclinical rhythmic electrographic discharges of adults (SREDA), including sensitivity to hyperventilation. Conclusions: LGI1-antibody mediated encephalitis may be associated with tonic seizures and corresponding electrodecremental events, as well as an unusual SREDA-like pattern of frequent subclinical temporal lobe seizures, which may be triggered by hyperventilation, all in the setting of rare interictal epileptiform discharges.
D.09 Pharmacological therapy for the prevention and management of cardiomyopathy in Duchenne muscular dystrophy: a systematic review
Authors: El-Aloul B , Rodrigues R , Altamirano-Diaz L , Malvankar M , Nguyen C , Campbell C
Published: June 2016

Background: Improved respiratory care of Duchenne muscular dystrophy (DMD) patients has unmasked cardiomyopathy as a major source of morbidity and mortality. There is currently no consensus regarding the management of DMD-associated cardiomyopathy (DMD-CM). The objective of this systematic review was to evaluate the efficacy of pharmacological therapies for prevention and management of DMD-CM, and determine the optimal timing to commence these interventions. Methods: A systematic search was conducted in October 2015 and updated in January 2016 using MEDLINE, EMBASE and CINAHL databases and 9 grey literature sources for studies evaluating the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB) or aldosterone antagonists (AA) in DMD patients. References of retrieved records were searched. Quality assessment was conducted using the Downs and Black Quality Assessment Checklist. PRISMA reporting guidelines were used. Results: The 11 included studies were of low methodological quality. However, the use of an ACEi, ARB, BB and AA tended to improve or preserve left ventricular systolic function and delay the progression of cardiomyopathy. Conclusions: While there is evidence supporting the use of heart failure medication in patients with DMD-CM, data regarding these interventions for delaying the onset of DMD-CM and when to initiate therapy is lacking.
D.11 Trends in cerebral palsy in Saskatoon, Saskatchewan in the last four decades
Authors: Sawicka K , Rooks K , Dzus A , Norton J
Published: June 2016

Background: Cerebral Palsy (CP) is a neurological condition arising from a perinatal or intra-uterine stroke. In the past 25 years there has been a revolution in neonatal care. For over 40 years children with CP in and around Saskatoon have been treated through the Kinsman Childrens’ Centre (KCC). This is a unique population database covering all CP patients in the region. We analyzed the KCC database to determine if the recent changes in neonatal care were correlated with the incidence of CP co-morbidities. Methods: A retrospective study using a Saskatchewan database of cerebral palsy data from the last four decades. Results: Over the last 40 years the incidence of visual disturbance and diagnoses of epilepsy in children with CP have remained stable regardless of advances in neonatal care. However, incidences of spine and hip issues requiring orthopedic intervention have halved. Conclusions: We hypothesize that advances in neonatal care have been successful in decreasing the incidence of gross motor impairments however have yet to significantly impact impairments relating to cortical network function. Although improvements in care have resulted in a decreased burden of disability, there remains opportunity for further improvements, especially in the settings of epilepsy and long-term visual function.
E.04 Coma and delirium are associated with low levels of brain tissue oxygen in critically ill patients
Authors: Wood MD , Maslove D , Muscedere J , Boyd JG
Published: June 2016

Background: The cause of ICU delirium is unknown. We used near infrared spectroscopy (NIRS) to measure brain tissue oxygenation (BtO2) in critically ill patients, to test the hypothesis that poor cerebral oxygen delivery contributes to ICU delirium. Methods: Adult patients were enrolled if they required mechanical ventilation for >24 hours, and/or vasoactive agents. Patients were excluded if they had previous cognitive dysfunction, brain injury on admission, or a life expectancy <24 hours. BtO2 was measured for the first 24 hours of ICU admission. The confusion assessment method-ICU (CAM-ICU) was used to screen for delirium. Participants were designated to one of three groups on the basis of their predominant neurological status (comatose, delirious, or intact). Results: To date, 47 patients have been recruited. Both delirious and comatose patients’ had significantly lower BtO2 levels compared to intact patients (P<0.001). There was a significant correlation between hemoglobin and BtO2 (R2=0.347, P<0.01). However, when correlation analysis was conducted separately amongst the three groups, the delirious patients (R2=0.485, P<0.05) were the strongest contributors to this positive correlation. Conclusions: Delirious patients exhibited the lowest BtO2 recordings and demonstrated a significant association between Hb and BtO2. This study offers potential insight into the pathophysiology of ICU delirium.
E.11 Non-invasive ventilation in patients with amyotrophic lateral sclerosis: practice patterns amongst Canadian care providers
Authors: Chum MC , Gofton T , Shoesmith C
Published: June 2016

Background: The purpose of this study was to: 1) describe current non-invasive ventilation (NIV) usage patterns amongst Canadian ALS healthcare providers; 2) compare/contrast with previous practice patterns; and 3) explore barriers to NIV access encountered by current practitioners. Methods: Healthcare professionals (including physicians, respiratory therapists, and nurses) at major Canadian ALS care centres were sent a web-based survey. Participants were asked to provide input on practice demographics, access and initiation of NIV, and follow-up of NIV. Quantitative data were analyzed with descriptive and comparative statistics, while qualitative data were analyzed using interpretative phenomenological analysis method to identify emergent themes. Results: 26 participants responded. Median NIV usage was 39% (range 10-100%), about double of what was previously reported (18%). Mean times from referral to routine and urgent NIV initiation were 13 (95% CI 9-17) and 5 (95% CI 3-7) days respectively. NIV was most commonly initiated in clinic (68%), while 38% report having access to home-NIV initiation. Lack of social support (62%) and cognitive impairment (46%) were the most common deterrents to initiating NIV. Similar to what is previously reported, barriers to access can be stratified to patient, clinical, institutional, and regional levels. Conclusions: Despite increased usage and improved access, there remain considerable barriers for ALS patients to receive NIV.
F.01 Prognostic factors in adults with spinal cord injury without radiological abnormalities (SCIWORA): MRI study
Authors: Martinez-Perez R , Paredes I , Cotrina J , Pandey S , Lagares A
Published: June 2016

Background: Spinal Cord Injury Without Radiological Abnormality (SCIWORA) is underreported and poorly recognized in adults. This entity is an important subtype of spinal cord injury (SCI) with relatively good outcomes. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Methods: A retrospective review of adult patients with cervical SCI admitted to two University hospitals from January 2000 to December 2010 was performed. Only patients with an MRI performed within 72 hours after trauma were included. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurological condition and MRI results. Results: 49 patients selected. Patients with extramedullary hemorrhage showed worse neurological status at initial examination. Disruption of either the anterior longitudinal ligament or ligamentum flavum was associated with worse outcomes at initial examination and at 1-year follow up. Lesion length was also significantly associated with outcomes at 1 year evaluation and initial evaluation. Conclusions: Early MRI has an important prognostic value in patients suffering SCIWORA. Lesion length is a powerful predictor of outcome. Soft tissue injury and spinal cord changes play a role in the severity of injury as well as the ability to recover.
Biological approaches to characterize the mode of action of two 5-nitroindazolinone prototypes onTrypanosoma cruzibloodstream trypomastigotes
Authors: FONSECA-BERZAL CRISTINA , DA SILVA CRISTIANE FRANÇA , MENNA-BARRETO RUBEM F. S. , BATISTA MARCOS MEUSER , ESCARIO JOSÉ A. , ARÁN VICENTE J. , GÓMEZ-BARRIO ALICIA , SOEIRO MARIA DE NAZARÉ C.
Published: June 2016

The phenotypic activity of two 5-nitroindazolinones, i.e. 2-benzyl-1-propyl (22) and 2-benzyl-1-butyl (24) derivatives, previously proposed as anti-Trypanosoma cruziprototypes, was presently assayed on bloodstream trypomastigotes (BT) of the moderately drug-resistant Y strain. Further exploration of putative targets and cellular mechanisms involved in their activity was also carried out. Therefore, transmission electron microscopy, high-resolution respirometry and flow cytometry procedures were performed on BT treated for up to 24 h with the respective EC50value of each derivative. Results demonstrated that although 22 and 24 were not as active as benznidazole in thisin vitroassay on BT, both compounds triggered important damages inT. cruzithat lead to the parasite death. Ultrastructural alterations included shedding events, detachment of plasma membrane and nuclear envelope, loss of mitochondrial integrity, besides the occurrence of a large number of intracellular vesicles and profiles of endoplasmic reticulum surrounding cytoplasmic organelles such as mitochondrion. Moreover, both derivatives affected mitochondrion leading to this organelle dysfunction, as reflected by the inhibition in oxygen consumption and the loss of mitochondrial membrane potential. Altogether, the findings exposed in the present study propose autophagic processes and mitochondrial machinery as part of the mode of action of both 5-nitroindazolinones 22 and 24 onT. cruzitrypomastigotes.
Immunodiagnostic monoclonal antibody-based sandwich ELISA of fasciolosis by detection ofFasciola giganticacirculating fatty acid binding protein
Authors: ANURACPREEDA PANAT , CHAWENGKIRTTIKUL RUNGLAWAN , SOBHON PRASERT
Published: June 2016

Up to now, parasitological diagnosis of fasciolosis is often unreliable and possesses low sensitivity. Hence, the detection of circulating parasite antigens is thought to be a better alternative for diagnosis of fasciolosis, as it reflects the real parasite burden. In the present study, a monoclonal antibody (MoAb) against recombinantFasciola giganticafatty acid binding protein (rFgFABP) has been produced. As well, a reliable sandwich enzyme-linked immunosorbent assay (sandwich ELISA) has been developed for the detection of circulating FABP in the sera of mice experimentally and cattle naturally infected withF. gigantica. MoAb 3A3 and biotinylated rabbit anti-recombinant FABP antibody were selected due to their high reactivities and specificities. The lower detection limit of sandwich ELISA was 5 pg mL−1, and no cross-reaction with other parasite antigens was observed. This assay could detectF. giganticainfection from day 1 post infection. In experimental mice, the sensitivity, specificity and accuracy of this assay were 93·3, 100 and 98·2%, while in natural cattle they were 96·7, 100 and 99·1%. Hence, this sandwich ELISA method showed high efficiencies and precisions for diagnosis of fasciolosis byF. gigantica.