bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental and Ecological Effects of Climate Change on Venomous Marine and Amphibious Species in the Wilderness
Authors: Needleman Robert K. , Neylan Isabelle P. , Erickson Timothy B.
Published: June 2018

Introduction

Recent analyses of data show a warming trend in global average air and sea surface ocean temperatures. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, the sea level has risen, and the concentrations of greenhouse gases have increased. This article will focus on climate change and projected effects on venomous marine and amphibious creatures with the potential impact on human health.

Methods

Retrospective analysis of environmental, ecological, and medical literature with a focus on climate change, toxinology, and future modeling specific to venomous aquatic and amphibious creatures. Species included venomous jellyfish, poisonous fish, crown-of-thorns starfish, sea snakes, and toxic frogs.

Results

In several projected scenarios, rising temperatures, weather extremes, and shifts in seasons will increase poisonous population numbers, particularly with certain marine creatures like jellyfish and crown-of-thorns starfish. Habitat expansions by lionfish and sea snakes are projected to occur. These phenomena, along with increases in human populations and coastal development will likely increase human−animal encounters. Other species, particularly amphibious toxic frogs, are declining rapidly due to their sensitivity to any temperature change or subtle alterations in the stability of their environment. If temperatures continue to rise to record levels over the next decades, it is predicted that the populations of these once plentiful and critically important animals to the aquatic ecosystem will decline and their geographic distributions will shrink.

Conclusion

Review of the literature investigating the effect and forecasts of climate change on venomous marine and amphibious creatures has demonstrated that temperature extremes and changes to climatic norms will likely have a dramatic effect on these toxicological organisms. The effects of climate change on these species through temperature alteration and rising coastal waters will influence each species differently and in turn potentially affect commercial industries, travel, tourism, and human health.
Diagnostic utility of flexible fiberoptic nasopharyngolaryngoscopy recorded onto a smartphone: A pilot study
Authors: Brant Jason A. , Leahy Kevin , Mirza Natasha
Published: June 2018

Objectives

To evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded onto smartphones.

Methods

Prospective, blinded study of inpatients requiring laryngoscopy. A live exam was performed, then a smartphone was attached to the endoscope using a novel coupling device and the same examination was recorded. The live and recorded exams were evaluated by two laryngologists, each blinded to the findings of the other.

Results

Eighteen subjects were evaluated. Evaluation of airway patency was identical (Kappa = 1.0 [1, 1]). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa = 0.69 [0.38, 1]).

Conclusion

There is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings using a coupling device to transfer the recordings on to smartphones. Critical findings such as airway patency and vocal fold motion showed the highest correlation.
Editorial
Authors: Babinsky Holger
Published: June 2018

It is an enormous honour for me to take over from Peter Bearman as Editor-in-Chief of the world's oldest aeronautics journal. Most of you will not know me and thus I'd like to give you a bit of background: I grew up in Bavaria and studied Aerospace Engineering at Stuttgart University. Under the German system it was common to work on the final research project (Diploma thesis) outside the University and I was lucky enough to find a suitable place in Cranfield. There, my supervisor was John Stollery, who led this journal as Editor-in-Chief for many years. After a PhD in hypersonic aerodynamics (also at Cranfield) I became a post-doctoral researcher at Tohoku University in Japan. 18 months later I returned to the UK to take up a lectureship in aerodynamics at the Engineering Department of Cambridge University where I am now the Professor of Aerodynamics, Head of the Fluids Group and Deputy Head of Department with responsibility for graduate education.
C.05 Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: a prospective observational study and systematic review
Authors: Hachem LD , Mansouri A , Scales DC , Geerts W , Pirouzmand F
Published: June 2018

Background: Venous thromboembolism (VTE) is a serious complication following severe TBI, however, anticoagulant prophylaxis is often withheld over concerns of intracranial hemorrhage (ICH) progression. We analyzed practice patterns and outcomes among severe TBI patients and systematically reviewed the literature for studies of anticoagulant prophylaxis after severe TBI. Methods: We prospectively screened consecutive patients with severe TBI (highest GCS≤8 from time of injury to ICU admission) admitted to a Level-I trauma centre between Oct 1,2015–Sept 30,2016 to assess type/timing of anticoagulant prophylaxis, rates of new VTE and ICH progression. Results: We identified 64 eligible patients with severe TBI. Most (53;83%) received anticoagulant prophylaxis, initiated ≥3d after TBI in 67%. Ten (16%) developed VTE during hospitalization; 8 started prophylaxis prior to VTE. No significant difference was observed in VTE incidence or ICH progression between patients with early prophylaxis (<3d) vs.later (≥3d). Our systematic review identified 5 studies of heterogeneous quality/design, with reported VTE incidence of 11-30% in patients without anticoagulant prophylaxis and 5-10% in patients with prophylaxis. Conclusions: VTE is a common complication after severe TBI despite routine use of anticoagulant prophylaxis. Anticoagulant prophylaxis is often started late (≥3d) post-injury. The relative benefits of early prophylaxis versus possible risks of ICH progression should be directly compared in an appropriately powered RCT.
P.001 Factors associated with having a will, power of attorney and advanced healthcare directive in patients presenting to a rural and remote memory clinic
Authors: Lee S , Kirk A , Karunanayake C , O’Connell M , Kirk E , Morgan D
Published: June 2018

Background: A will, power of attorney and advanced healthcare directive are critical to guide decision-making in people with cognitive decline. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). Methods: 95 consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they have legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. Results: 70 patients had a will, 62 had a power of attorney and 21 had an advanced healthcare directive. Having a will was associated with good quality of life (p=0.001), living alone (p=0.034), poor verbal fluency (p=0.055) and European ethnicity (p=0.028). Factors associated with having a power of attorney included good quality of life (p=0.031), living alone (p=0.053) and poor verbal fluency (p=0.015). Old age (p=0.015), poor verbal fluency (p=0.023) and severity of cognitive and functional impairment (p=0.023) were associated with having an advanced healthcare directive. Conclusions: Our results indicate that poor quality of life, good verbal fluency, non-European ethnicity and living with others are associated with a lower likelihood of creating legal documents in patients with cognitive decline
P.003 Feasibility and validity of a novel video-conference administration protocol for the NIH toolbox - cognition battery
Authors: Rebchuk AD , Deptuck HM , O’Neill ZR , Fawcett DS , Silverberg ND , Field TS
Published: June 2018

Background: The NIH Toolbox - Cognition Battery (NIHTB-CB) is a computerized cognitive assessment designed for clinical research that is administered in-person. Here, we explored the feasibility and validity of a novel video-conference protocol for administering the NIHTB-CB. Since our protocol required repeated assessments, we further explored the NIHTB-CB’s practice effect. Methods: Twenty-five healthy participants completed the NIHTB-CB under two separate conditions four weeks apart. The standard condition followed the recommended administration protocol, whereas the video-conference condition had the examiner and participant in separate rooms but able to communicate over video-conference. A linear mixed-model analysis was performed to explore the fixed effect of testing condition and time on NIHTB-CB performance. Results: Across all three NIHTB-CB composite scores (total, fluid and crystallized cognition) no significant fixed effect of administration condition was found. A significant practice effect was observed for the fluid and total cognition composite scores over a 29.0 (± 2.1) day test-retest interval. Conclusions: Our novel video-conference protocol for the NIHTB-CB is equivalent to the standard protocol in healthy participants, and may provide a solution for researchers seeking to engage study participants at remote sites. If the NIHTB-CB is used longitudinally to monitor patients, corrections for repeated measures may be required.
P.004 Neurogenic orthostatic hypotension results in impaired information processing speed
Authors: Robinson L , Kimpinski K
Published: June 2018

Background: Neurogenic orthostatic hypotension (NOH) is characterized by a reduction in systolic blood pressure of ≥20 mmHg or diastolic blood pressure of ≥10 mmHg within three minutes of upright posture. NOH is prevalent in the elderly population who is at increased risk for cognitive decline, therefore it is imperative to investigate if there is a relationship between NOH and impaired cognition. Methods: Currently, 9 control subjects and 4 NOH patients have been recruited. Cognitive function is assessed using the symbol digit modalities test (SDMT) which assesses information processing speed and the Stroop test which measures response inhibition. SDMT and Stroop test are administered when the table is supine and during tilt. Results: NOH patients scored significantly worse on SDMT when lying (p=0.018) and standing (p=0.004) compared to the control group. Control subjects performed significantly better when standing for both SDMT (p=0.008) and Stroop (p=0.026), whereas NOH patients had similar scores when lying and standing for SDMT and Stroop. Conclusions: Preliminary results show that information processing speed is slower in NOH patients than controls in both the supine and standing positions. NOH patients have a more difficult time inhibiting unwanted responses compared to controls when standing, which is represented by a greater interference score in NOH patients.
P.011 Not just for babies: positive rolandic sharp waves in adult post-hypoxic myoclonus
Authors: McLeod GA , Ng MC
Published: June 2018

Background: Post-hypoxic myoclonus is broadly divided into myoclonic status epilepticus (MSE) and Lance-Adams syndrome (LAS), where diagnosis depends on clinical and electroencephalographic (EEG) findings. Positive rolandic sharp waves (PRS) are a classic EEG finding in pre-term infants with white matter necrosis, but they are not known to be epileptogenic and have never been described in adults. Methods: We report a unique case of PRS correlated with myoclonic seizures in a post-hypoxic adult patient. Results: Shortly after cardiac arrest, a 21-year-old woman developed multifocal post-hypoxic myoclonus. Early development of myoclonus suggested MSE, but her EEG findings were atypical for MSE; initially, the only notable feature on EEG were subtle PRS. LAS did not fit the clinical picture or EEG findings. As myoclonus persisted over the following weeks, PRS evolved on EEG into positive rolandic predominant generalized polyspike-wave complexes that became definitively time-locked to each myoclonic jerk. PRS were diagnosed as epileptogenic and frequent myoclonic jerks were diagnosed as continuous myoclonic seizure. Myoclonus resolved to medication and mental status returned to baseline. Conclusions: We report for the first time that PRS can appear in adult patients and be epileptogenic, and produce a non-classical variant of post-hypoxic myoclonus that carries good prognosis.
P.013 Convulsive status epilepticus due to intracranial hypotension
Authors: Gilmour GS , Scott J , Couillard P
Published: June 2018

Background: Intracranial hypotension (IH) is typically characterized by an orthostatic headache. There have been limited case reports describing iatrogenic IH presenting with seizures. Methods: Case report. Results: A 71-year-old woman with chronic back pain developed convulsive status epilepticus (SE), characterized by generalized clonic seizures, immediately following scoliosis surgery. She had no history of seizures or seizure risk factors. Despite treatment with Midazolam, Phenytoin and Lacosamide, seizures recurred five times over three hours. Thus, Propofol and Midazolam infusions were initiated. An electroencephalogram revealed burst suppression and bilateral hemispheric epileptiform discharges. MRI brain was consistent with IH without cortical vein thrombosis. Fluid from the surgical drains was positive for Beta-2 transferrin, indicating cerebral spinal fluid. Her intracranial hypotension was likely due to an -intraoperative dural tear causing SE. Over two weeks, she remained on bedrest, sedation was weaned, and Phenytoin and Lacosamide were tapered and discontinued. She had no further seizures. Conclusions: IH is an under recognized cause of seizure following spinal or cranial surgery, lumbar puncture, or spinal anaesthesia. Proposed mechanisms include traction on cortical structures, increased cerebral blood flow and cortical irritation secondary to subdural hygromas.
P.016 A novel de novo GABRA1 mutation linked to epileptic encephalopathy: pathophysiology and potential therapeutic options
Authors: Chiu M , Bai Y , Chan EH , Huh L , Guella I , Farrer MJ , Connolly M , Liu L , Demos M , Wang Y
Published: June 2018

Background: Epileptic encephalopathy (EE) is a severe neurological disorder characterized by treatment-resistant seizures and poor neurodevelopmental outcomes. EE is associated with mutant genes, including those that encode for γ-aminobutyric acid type A (GABAA) receptor subunits. We identified a novel de novo GABRA1 mutation in a patient with EE, characterized its impact on GABAA receptor function, and sought potential therapeutic options. Methods: We described the clinical and electrophysiological features of a patient with a novel de novo GABRA1 (R214C) mutation; performed functional studies; and determined the effect of diazepam and insulin on wild type and mutant GABAA receptors. Results: The patient is a 10-year-old girl with EE, treatment-resistant seizures, intellectual disability and autism. Her GABRA1 (R214C) mutation dramatically decreased whole-cell GABA-evoked currents by reducing GABAA surface receptors, decreasing single channel open time, and altering channel kinetic properties. The combination of diazepam and insulin partially repaired these effects by enhancing channel activity and increasing the number of surface receptors, respectively. Conclusions: Diazepam and insulin partially mitigated a de novo GABRA1 (R214C) mutation’s effects on GABAA receptor number and function. Given the risks of insulin use, pharmacological agents with similar mechanisms of action but fewer side effects, such as IGF-1, should be studied and considered for clinical application.
P.017 Results of a Pilot feasibility study to develop reduce wait times strategy in the evaluation of children with new onset epilepsy
Authors: Mailo JA , Diebold M , Mazza E , Guertjens P , Gangam H , Levin S , Campbell C , Prasad AN
Published: June 2018

Background: The goal was to understand factors leading to prolonged wait times for neurological assessment of children with new onset seizures. A second objective was to develop an innovative approach to patient flow through and achieve a reduction in waiting times utilizing limited resources.

Methods:

Audit of the referrals, flow through, wait times

Identification of bottlenecks

Development of triaging strategy:

Suspected Febrile seizures and non-epileptic events;

Suspected benign and absence epilepsies;

Suspected other Focal epilepsies, generalized epilepsies, epilepsy under 2 years

Initiation of early telephone contact and support

Development of a ketogenic diet

Results: Using a triaging strategy and focusing on timely access to investigations, wait times for clinic evaluations were shortened despite larger numbers of referrals (mean wait time reductions from 179 to 91 days). Limiting factors such increase in referral numbers, attrition in support staff, interfered with sustainability of reduced wait times achieved in the initial phase of the program. Conclusions: This pilot study highlights the effectiveness of an innovative triaging strategy and improvements in patient flow through in achieving the goals of reduction in wait times for clinical evaluation and timely investigations to improve care for children with new onset seizures. Insights into limitations of such strategies and factors determining sustainability are discussed.
P.025 Is this headache normal?: Assessing electronic referrals for headache from primary care physicians
Authors: Panamsky L , Bradi A , Sitwell L , Liddy C , Afkham A , Keely E
Published: June 2018

Background: Headache is one of the most frequent complaints in primary care. We reviewed headache questions submitted to an electronic consultation service in Ontario to classify the types of headaches and describe the questions being asked. We also identified reasons why answers were not retrievable within UpToDate, an online clinical resource. Methods: 65 headache eConsults were further divided into 85 questions and categorized by headache type and question theme. Questions were manually searched within UpToDate to determine if they could be answered using this resource. The intent to refer the patient for a face-to-face referral after the eConsult was collected. Results: The top classifications were migraine, unclassified headache, and exertional and/or coital headache. The themes -identified were medication questions (41.7%), investigation questions (33.3%), clinical concerns despite normal neurologic exam and/or imaging (15.5%); and abnormal imaging findings (9.5%). Answers to 40.1% of the questions were not retrievable in UpToDate. The main reason for irretrievability was an unusual presentation. Only 33.8% of eConsults resulted in a face-to-face referral to a specialist. Conclusions: Although electronic resources may be useful in some cases, clinical nuances cannot be accounted for. By providing physicians with rapid access to specialists, eConsult services may obviate the need for formal, face-to-face referrals.
P.029 Case report: pediatric enterovirus encephalitis - a rare complication of rituximab therapy
Authors: Sham L , Yeung R , Dell S , Bitnun A , Johnstone J , Yeh E
Published: June 2018

Background: Opportunistic infection should be considered when seeing neurological complications in the setting of immunosuppression. Accumulating evidence that enteroviral meningoencephalitis can occur after rituximab administration exists but differentiating it from non-infectious conditions can be challenging. Methods: Case report Results: We describe a 4 year-old-boy with a history of pulmonary capillaritis, treated with immunosuppressive therapy -including steroids, rituximab, and azathioprine. He developed mutism and ataxia after 18 months on rituximab. MRI Brain/Spine revealed extensive T2/FLAIR hyperintensities in the deep subcortical white matter, temporal lobes, globus pallidi, thalami, brainstem, and cerebellum; and swelling of the dorsal cervical cord, showing primarily grey matter involvement. IgG levels had a decreasing trend over the course of Rituximab. CSF, and subsequent brain biopsy, were both positive for enterovirus RNA by RT-PCR. He was thought to have enterovirus encephalitis secondary to rituximab therapy, and was treated with IVIG and fluoxetine. Conclusions: One should consider chronic opportunistic CNS infections in children treated with immunosuppressive therapy, and to consider chronic enterovirus infection when B-cell suppression has occurred. As rituximab is being increasingly used in the pediatric population, and is generally thought to be safe, attention should be paid to any child with chronic neurological signs, particularly younger children who may be at higher risk for chronic enterovirus infection.
P.036 Securing the nasoseptal flap in endoscopic transsphenoidal surgery: no Foley catheter needed!
Authors: Massoud E , Hebb AL , Clarke DB
Published: June 2018

Background: The nasoseptal flap, commonly used in endoscopic transsphenoidal surgical, is typically held in position for several days post-operatively by a nasal Foley catheter balloon. The purpose of this study is to describe our experience with an alternative technique to buttress the nasoseptal flap that renders the use of a Foley catheter unnecessary. Methods: A review of our Halifax Neuropituitary Program’s database identified patients who underwent endoscopic transsphenoidal surgery for a pituitary macroadenoma with nasoseptal flap, secured with small rolls of GelfoamTM rather than a nasal Foley catheter. Minimum follow-up clinical and MRI assessments: 3 months. Results: 69 patients (mean follow-up: 22 months) met the inclusion criteria: 53 non-functioning and 16 functioning pituitary adenomas. 36 patients had an intraoperative CSF leak: 29 high flow and 7 low flow leaks. 35 patients were repaired by a fat +/- fascia graft. One patient had a post-operative CSF leak repaired by subsequent surgery without the use of a Foley catheter. Conclusions: In our experience, 1 of the 69 (1.4%) patients required post-operative CSF leak repair, well within the incidence of 1 to 3% reported in the literature. Securing the nasoseptal flap can be achieved without the use of a nasal Foley catheter.
P.038 Investigating the role of long non-coding RNAs in glioblastoma multiforme
Authors: Lebel A , Charest V , Whitlock P , Charest D , Morin P
Published: June 2018

Background: Malignant gliomas are the most common and deadly brain tumors. Mean survival rate for a patient diagnosed with a glioblastoma multiforme (GBM) remains slightly over one year. Standard of care consists of treatment with temozolomide (TMZ) and radiotherapy. Recent work has highlighted functions of long non-coding RNAs (lncRNAs) in GBM progression and TMZ response even though the information regarding these newly discovered molecules is sparse. The overarching objective of this project was thus to assess the expression of select lncRNAs in GBM tumor samples and in models of TMZ resistance. Methods: A qRT-PCR-based approach was undertaken to measure six lncRNAs in 19 primary GBM samples, four GBM cell lines and in-house developed TMZ-resistant GBM cells. Results: Elevated levels of Hotair and H19 were observed in primary GBM tumors while decreased expression of MEG3 was recorded in the same samples. Interestingly, levels of PANDA increased 3.4-fold in GBM cells resistant to TMZ when compared with their sensitive counterparts. Conclusions: Overall, this work provides evidence of lncRNA deregulation in GBM tumors and reveals a previously unexplored lncRNA potentially involved in TMZ resistance. Modulation of lncRNA targets via RNAi-mediated approaches is envisioned to clarify their function and to strengthen their position as therapeutic options in GBMs.
P.040 New-onset secondary hormone deficiency in patients with incidental versus clinically manifesting sellar masses
Authors: Vaninetti N , Mustafa S , Doucette S , Glasgow R , Tramble L , Hebb AL , Imran S , Clarke* DB
Published: June 2018

Background: Secondary hormonal deficiency (SHD) in patients with sellar masses (SM) is associated with significant morbidity. Purpose: to compare long-term risk of new-onset SHD in SM found incidentally (ISM) versus those clinically manifesting (CMSM). Methods: From the Halifax Neuropituitary Program’s database, we identified all patients having non-functioning and non-pituitary SM from January 1, 2006, with ≥ 12 months follow-up. Results: There were 214 CMSM (108 with baseline SHD) and 148 ISM (37 with baseline SHD) patients (mean follow-up: 5.7 and 5.0 years, respectively). In patients who underwent early surgery (<90 days from diagnosis), 3-month post-op hormonal function was considered baseline. Despite unchanged tumour size in over 95%, 129 (35.6%) developed new-onset SHD at up to 120 months. The risk of developing new-onset SHD was similar in CMSM and ISM groups (HR = 1.10; CI= 0.69-1.75; p= 0.7), and in surgical and nonsurgical patients (HR=1.24; CI= 0.59-2.61; p = 0.58). Conclusions: More than one third of patients with non-functioning or non-pituitary SM, presenting either with clinical manifestations or as incidental lesions, will develop new-onset SHD. Furthermore, SHD may develop several years later and despite stability of tumors, highlighting the need for ongoing, long-term hormonal assessment.
P.042 Raloxifene sensitizes glioblastoma cells to hypoxia-induced death through inhibition of stress granule dissolution
Authors: Robichaud A , Attwood K , Balgi A , Roberge M , Weeks A
Published: June 2018

Background: Glioblastoma (GBM) is the most common primary malignant brain tumour. Despite aggressive therapy, median survival is only 14 months. Death typically results from treatment failure and local recurrence. The GBM microenvironment is highly hypoxic, which correlates with treatment resistance. Cytoplasmic RNA stress granules (SGs) form in response to hypoxic stress and act as sights of mRNA triage, allowing preferential translation of pro-survival mRNA during stress. We hypothesize that SGs may play a role in hypoxia-induced resistance to therapy, and may be targetable by chemotherapeutics to improve outcomes. Methods: We screened 1280 approved compounds to identify drugs that inhibited formation or dissolution of SGs in U251 glioma cells. Raloxifene inhibited SG dissolution in a dose dependent manner. We treated cells with raloxifene and incubated them in hypoxia, and then measured rates of cell death using cell counting and Presto blue. Results: Cell death rates were synergistically higher in cells treated with the combination of raloxifene and hypoxia compared to either treatment alone. Conclusions: Raloxifene inhibits the dissolution of SGs in glioma cells, and combination treatment results in synergistic tumour cell death. Taken together, this provides evidence that inhibition of SG dissolution may be a viable target for future GBM chemotherapeutics.
P.063 Stereotactic targeting of hippocampal substructures using ultra-high field magnetic resonance imaging: Feasibility study in patients with epilepsy
Authors: Lau JC , DeKraker J , MacDougall KW , Joswig H , Parrent AG , Burneo JG , Steven DA , Peters TM , Khan AR
Published: June 2018

Background: The hippocampus can be divided longitudinally into the head, body, and tail; and unfolded medial-to-laterally into the subiculum, cornu ammonis (CA) sectors, and the dentate gyrus. Ultra-high field (≥ 7 Tesla; 7T) magnetic resonance imaging (MRI) enables submillimetric visualization of these hippocampal substructures which could be valuable for surgical targeting. Here, we assess the feasibility of using 7T MRI in conjunction with a novel computational unfolding method for image-based stereotactic targeting of hippocampal substructures. Methods: 53 patients with drug-resistant epilepsy were identified undergoing first-time implantation of the hippocampus. An image processing pipeline was created for computationally transforming post-operative electrode contact locations into our hippocampal coordinate system. Results: Of 178 implanted hippocampal electrodes (88 left; 49.4%), 25 (14.0%) were predominantly in the subiculum, 85 (47.8%) were in CA1, 23 (12.9%) were in CA2, 18 (10.1%) were in CA3/CA4, and 27 (15.2%) were in dentate gyrus. Along the longitudinal axis, hippocampal electrodes were most commonly implanted in the body (92; 51.7%) followed by the head (86; 48.3%). Conclusions: 7T MRI enables high-resolution anatomical imaging on the submillimeter scale in in vivo subjects. Here, we demonstrate the utility of 7T imaging for identifying the relative location of SEEG electrode implantations within hippocampal substructures for the invasive investigation of epilepsy.
P.081 Popularity of online multimedia educational resources in neurosurgery: Insights from The Neurosurgical Atlas project
Authors: Davidson B , Alotaibi NM , Hendricks BK , Cohen-Gadol A
Published: June 2018

Background:The Neurosurgical Atlas is a neurosurgical website with informative chapters and videos to promote excellence and safety in neurosurgical techniques. Here, we present our analysis of this website’s viewing data and describe how online neurosurgical resources are being utilized. We hope this will be a useful guide for neurosurgeons interested in online multimedia education. Methods: We analyzed Google Analytics data from The Neurosurgical Atlas between June 2016 and August 2017 which tracked user demographics, geographical location, and the videos watched. Views were also analyzed categorically by dividing videos into six neurosurgical topics and into basic and advanced levels as per their surgical complexity. Results: There were 246,259 website visits and 143,868 video plays. The most frequent age groups were 25-34 (44%) and 35-44 (24%). 71% of visitors were male. Most visitors were from the US (29.52%) and Brazil (6.43%). Website visits and video plays increased over time, with multiple peaks corresponding to promotional email updates. The six neurosurgical topics were all similarly popular. Conclusions: Our study presents the first piece of evidence demonstrating the feasibility and popularity of a free online resource in neurosurgical education. Our experience highlights the growing demand for free-access online chapters, anatomical illustrations, and operative videos.
P.090 Risk factors and etiology of stroke in young adults: a 6-years retrospective hospital-based study, OMAN
Authors: Hashmi AM Al , Jose S , Mawali S Al
Published: June 2018

Background: Stroke in the young is particularly tragic because of its potential for life time disability. Although a large number of studies have been published Worldwide. Very few have looked at etiologies in the youth of the Middle East,and none have focused on Oman. Methods: Retrospective,single center study,carried out at the Royal Hospital in Muscat. Chart review identifying all patients under 50 years of age admitted for acute stroke from 2009-2014. We analyzed the detailed history,examination and brain imaging (CT or MRI) for each case. We identified 588 young patients,163 of these were excluded due to other diagnosis or absence of neuroimaging (CT or MRI). Results: Out of the 425 stroke cases,67.3% were men. IS occurred in 69.6% compared to 30.4% for HS. Hypertension was the number one risk factor for both IS and HS,with a prevalence 50.7% and 60.5% respectively. DM was the second leading risk factor,with a prevalence of 32.1% in IS and 27.1% in HS. Underlying etiologies were identified in only 35.5% of cases in IS and 29.5% in HS.Cardiac etiology and vasculopathy were commonest for IS. Aneurysm was the main underlying etiology for HS. Conclusions: IS was more frequent than HS.Hypertension and DM were the leading risk factors for both stroke subtypes. Cardioembolism and vasculopathy were the main etiologies for IS.Cerebral aneurysm for HS.
P.093 Hemoglobin values, fluctuations from baseline, and transfusion as predictors of outcome following aneurysmal subarachnoid hemorrhage
Authors: Eagles ME , Tso MK , Macdonald RL
Published: June 2018

Background: Anemia following aneurysmal subarachnoid hemorrhage (aSAH) has been associated with poor outcome, but complications from transfusion have limited aggressive management of anemic patients. This study examined the relationship between hemoglobin levels, transfusion and outcome following aSAH. Methods: We performed a post-hoc analysis of the CONSCIOUS-1 trial. Poor outcome was defined as a 3-month modified Rankin Scale > 2. Minimum hemoglobin levels were evaluated as predictors of outcome using logistic regression analysis, ROC curve analysis, and LOWESS curves. Propensity score matching was used to assess the effect of transfusion on poor outcome in patients with minimum hemoglobin levels between 70-90 and 80-100 g/L. Results: Lower minimum hemoglobin levels were associated with poor outcome on both univariate (p<0.001) and multivariate (p=0.012) analysis. Area under the ROC curve for minimum hemoglobin was 0.673. Youden index analysis found a minimum hemoglobin threshold of 91.5 g/L maximally predictive for good functional outcome. Propensity score matching showed a trend towards poor outcome in transfused patients with minimum hemoglobin levels between 70-90 and 80-100 g/L (p=0.052 and 0.09). Conclusions: This work suggests that decreasing hemoglobin is an independent predictor of poor outcome following aSAH. However, there was a trend towards poor outcome in transfused patients. The optimal transfusion threshold should be evaluated by prospective trials.
P.095 Holey Spinal Cord - A case of spinal cord stroke secondary to fibrocartilaginous embolism
Authors: Wasyliw S , Masiowski P
Published: June 2018

Background: Fibrocartilaginous embolism (FCE) is a rare reported cause of spinal cord infarction and likely underdiagnosed due to clinical unfamiliarity. FCE can present after a mild trauma and is characterized by back or neck pain along and a rapidly progressive myelopathy. We present a case of FCE and discuss how this clinical entity can break the typical rules of stroke. Methods: Case presentation Results: An otherwise healthy, 56-year-old professional sports coach presented a couple day history of progressive leg paresthesias and mild back pain, followed by unsteady gait and then inability to void. The left leg demonstrated mild weakness, hyperreflexivity, ataxia and an upgoing plantar response. The right leg became spastic and he then developed bilateral impairment of vibration and proprioception at the toes. An initial limited MRI lumbar spine was negative. A repeat MRI spine showed mild diffusion restriction of T10-11 and T11-12 and evidence of a bone infarct L2. He was diagnosed with a spinal cord infarct secondary to FCE. Conclusions: FCE should be considered in the differential for acute myelopathy. It can present with a progressive nature like transverse myelitis and MRI may be non-diagnostic. As more cases are being reported, FCE is becoming better defined and recognized.
P.111 Initial validation of symptom scores derived from the Orthostatic Discriminant and Severity Scale
Authors: Baker J , Paturel JR , Kimpinski K
Published: June 2018

Background: To develop a scale to quantify and discriminate orthostatic from non-orthostatic symptoms. We present initial validation and reliability of orthostatic and non-orthostatic symptom scores taken from the Orthostatic Discriminate and Severity Scale (ODSS). Methods: Validity and reliability were assessed in participants with and without orthostatic intolerance. Convergent validity was assessed by correlating symptoms scores with previously validated tools (Autonomic Symptom Profile (ASP) and the Orthostatic Hypotension Questionnaire (OHQ)). Clinical validity was assessed by correlating scores against standardized autonomic testing. Test-retest reliability was calculated using an intra-class correlation coefficient. Results:Convergent Validity: Orthostatic (OS) and Non-Orthostatic (NS) Symptom Scores from 77 controls and 67 patients with orthostatic intolerance were highly correlated with both the Orthostatic Intolerance index of the ASP (OS:r=0.903;NS:r=0.651; p<0.001) and the OHQ: (OS:r=0.800;NS:r=0.574; p<0.001). Clinical Validity: Symptom Scores were significantly correlated with the blood pressure change during head-up tilt (OS:r=-0.445;NS:r=-0.354; p<0.001). Patients with orthostatic intolerance had significantly higher symptom scores compared to controls (OS:66.5±18.1 vs. 17.4±12.9; NS:19.9±11.3 vs. 10.2±6.8; p<0.001, respectively). Test-retest reliability: Both symptom scores were highly reliable (OS:r=0.956;NS:r=0.574, respectively; p<0.001) with an internal consistency of 0.978 and 0.729, respectively. Conclusions: Our initial results demonstrate that the ODSS is capable of producing valid and reliable Orthostatic and Non-Orthostatic Symptom Scores.
P.117 A systematic review on opioid free analgesic techniques for supratentorial craniotomies
Authors: Sourour M , Darmawikarta D , Couban R , Yang K , Kamath S , Reddy KK , Shanthanna H
Published: June 2018

Background: Post-craniotomy pain can be severe and undermanaged. While opioids are the mainstay treatment, they have the potential to interfere with neurological monitoring. The objectives of this review are: 1) to identify measures to provide opioid-free analgesia 2) to compare the effectiveness of non-opioid to opioid analgesia in post-craniotomy pain. Methods: A comprehensive search of EMBASE, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases was conducted for RCTs evaluating the effect of opioid vs non-opioid pain control strategies in patients undergoing supratentorial craniotomy. Results: The literature search yielded 462 citations, 5 RCTs that met the inclusion criteria for a total of 250 patients. Scalp infiltration/block was found to provide equivalent analgesia to morphine1 and fentanyl.2 Morphine was associated with slightly higher postoperative nausea and vomiting. Paracetamol was less likely to induce nausea and vomiting,3,4 but provided inadequate pain relief compared to nalbuphine,3 tramadol,3 morphine4 and sufentanil.4 Dexmedetomidine5 provided similar analgesia to remifentanil but did delay the time to first dose of rescue analgesia with similar side effects. Conclusions: Based on the limited number of RCTs comparing opioid to non-opioid techniques, no definite recommendations can be made with regards to the optimal management of post-craniotomy pain. Considerations should be made for use of multimodal analgesia-including adjuvant analgesics.
P.123 Functional status in neurosurgery and out of hospital outcomes: insights from a 12 year, 2300 patient retrospective cohort study
Authors: Winkler-Schwartz A , Rydingsward JE , Christopher KB
Published: June 2018

Background: Limited information exists in neurosurgery regarding the association between functional status at hospital discharge and adverse events following discharge. Methods: A retrospective cohort study included all adults in one Boston teaching hospital who underwent neurosurgery between 2000-2012, survived hospitalization and had a Physical Therapist functional status assessment within 48-hours of discharge. 90-day post-discharge all-cause mortality was obtained from the US Social Security Administration Death Master File. Logistic regression analysis was used. Results: 2,369 patients were included, comprising 65% cranial and 35% spinal. Malignancy and trauma was 47% and 13%, respectively. 238 patients had independent functional status. 90-day mortality and readmission was 8.3% and 28%, respectively. Second, third and lowest quartile of functional status was associated with a 3.16 (95%CI 1.08-9.24), 6.00 (2.11-17.04) and 6.26 (2.16-18.16) respective increased odds of 90-day post-discharge mortality compared to patients with independent functional status, adjusting for age, gender, race, length of stay, presence of malignancy and Deyo-Charlson comorbidity. Good discrimination (AUC 0.82) and calibration (Hosmer-Lemeshow χ2 P = 0.23) were demonstrated. Adjusted odds of 90-day readmission in patients with the lowest quartile of functional status was 1.89 (1.28-2.80) higher than patients with independent functional status. Conclusions: Lower functional status at hospital discharge following neurosurgery is associated with increased post-discharge mortality and hospital readmission.
P.126 A nation-wide prospective multi-centre study of external ventricular drainage accuracy, safety, and related complications: Interim analysis
Authors: Dakson A , Kameda-Smith M , Staudt M , Althagafi A , Ahmed S , Bigder M , Eagles M , Elliott C , Fatehi M , Ghayur H , Guha D , Honey C , Iorio-Morin C , Lavergne P , Makarenko S , Persad A , Taccone M , Tso M , Winkler-Schwartz A , Sankar T , Christie S
Published: June 2018

Background: External ventricular drain (EVD) insertion is a common neurosurgical procedure performed in patients with life-threatening conditions, but can be associated with complications. The objectives of this study are to evaluate data on national practice patterns and complications rates in order to optimize clinical care Methods: The Canadian Neurosurgery Research Collaborative conducted a prospective multi-centre registry of patients undergoing EVD insertions at Canadian residency programs Results: In this interim analysis, 4 sites had recruited 46 patients (mean age: 53.9 years, male:female 2:1). Most EVD insertions occurred outside of the operating theatre, using free-hand technique, and performed by junior neurosurgery residents (R1-R3). The catheter tip was in the ipsilateral frontal horn or body of the lateral ventricle in 76% of cases. Suboptimally placed catheters did not have higher rates of short-term occlusion. EVD-related hemorrhage occurred in 6.5% (3/45) with only 1 symptomatic patient. EVD-related infection occurred in 13% (6/46) at a mean of 6 days and was associated with longer duration of CSF drainage (P=0.039; OR: 1.13) Conclusions: Interim results indicate rates of EVD-related complications may be higher than previously thought. This study will continue to recruit patients to confirm these findings and determine specific risk factors associated with them
P.127 Single centre review of lumboperitoneal shunt outcomes
Authors: Persad A , Meguro K
Published: June 2018

Background: Ventriculoperitoneal (VP) shunts are an established treatment modality for CSF diversion. An alternative to VP shunting is lumboperitoneal (LP) shunting. There is a paucity of evidence on LP shunt use in the literature, but available studies demonstrate that it is a safer and similarly efficacious method for conditions such as normal pressure hydrocephalies (NPH) and idiopathic -intracranial hypertension (IIH). Methods: Ventriculoperitoneal (VP) shunts are an established treatment modality for CSF diversion. An alternative to VP shunting is lumboperitoneal (LP) shunting. There is a paucity of evidence on LP shunt use, but available studies demonstrate that it is a safer and similarly efficacious method for conditions such as normal pressure hydrocephalies (NPH) and idiopathic intracranial hypertension (IIH). Results: 95 patients were treated with lumboperitoneal shunt, 71 of which were for hydrocephalus and 24 for IIH. 39 male and 58 female patients were included with mean age 55 (range from 20 to 96 years old). 26 patients had laparoscopic placement of the peritoneal catheter. Mechanical issues with distal end was less with laparoscopic approach. Conclusions: We will review disease-specific scores for NPH and IIH, and compare laparoscopic with non-laparoscopic placement of peritoneal catheter. We will also compare outcomes and complications with rates for VP shunting.
P.131 De novo PIK3CB mutation associated with macrocephaly and diffuse polymicrogyria
Authors: Kernohan KD , McMillan HJ , McBride A , Hartley T , Dyment DA , Boycott KM
Published: June 2018

Background: Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit beta (PIK3CB) is a member of the PI3K complex. This complex has two p110 members; PIK3CA (p110a) and PIK3CB (p110b) which are both ubiquitously expressed. PI3K complex functions to phosphorylate PIP2 to PIP3 which activates AKT and subsequently mTOR. PIK3CA mutations have been previously linked with macrocephaly and developmental delay. Methods: An 18 month old girl was investigated for severe hypotonia, developmental delay and macrocephaly. Head circumference was >97%ile at birth and 53.0 cm (>99%ile, +5.4 SD) at 13 months old. She had no hydrocephalus or epilepsy. MRI brain (18 months old) re-identified megalencephaly and diffuse polymicrogyria. Symmetric signal abnormality was noted in the periventricular white matter, unchanged between 8 and 18 month images. MR spectroscopy was unrevealing. At 18 months she remains unable to sit independently. Exome sequencing was performed and functional studies to further support variant pathogenicity. Results: Exome sequencing identified de novo variant in PIK3CB: c.1735G>T; p.Asp579Tyr. No mutations were noted in other genes known to cause developmental delay, macrocephaly or overgrowth syndromes. Functional studies in patient cells showed dysregulation of PIK3CB and downstream signalling, providing support for causality of this novel disease gene. Conclusions: We believe that our patient’s macrocephaly (+5.4 SD) and diffuse polymicrogyria results from altered PIK3CB function.
P.134 Infantile Onset Multisystem Neurologic, Endocrine and Pancreatic Disease: case series and review
Authors: Le C , Prasad AN , Debicki D , Andrade A , Rupar AC , Prasad C
Published: June 2018

Background: We report three brothers born to consanguineous parents of Syrian descent with a novel homozygous c.324G>A (p.W108*) mutation in PTRH2 that encodes mitochondrial peptidyl-tRNA hydrolase 2. Mutations in PTRH2 have recently been identified in the autosomal recessive condition, Infantile Onset Multisystem Neurologic, Endocrine and Pancreatic Disease (IMNEPD). To our knowledge, this is the first case of IMNEPD described in a Canadian centre. Methods: Clinical phenotyping enabled a targeted approach in which all exons of PTRH2 were sequenced. We identified a novel mutation and compared our patients with those recently described. Results: We identified a homozygous nonsense mutation in PTRH2, c.324G>A (p.W108*). This G to A mutation results in a premature stop at codon 108 that produces a truncated protein, removing most of the amino acids at the enzymatic active site. This mutation is not listed in the human Gene Mutation Database Cardiff, NCBI dbSNP, 1000 Genomes, Exome Variant Server or ClinVar and is a rare variant listed in gnomAD. Conclusions: In IMNEPD, nonsense mutations in PTRH2 appear to cause severe disease with postnatal microcephaly, neurodevelopmental regression, and ataxia with additional features of seizures, peripheral neuropathy, and pancreatic dysfunction, whereas missense mutations may produce a milder phenotype. The spectrum exhibited by our patients suggests variable expressivity with PTRH2 mutations.