bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Pregabalin Abuse with Subacute Encephalopathy Mimicking Autoimmune Encephalitis
Authors: Harsha Kamble Jayaprakash , Joshy EV , Aravinda Rangenahalli Vasudev , Poornima Rangareddy 
Published: December 2021

Abstract
Pregabalin, a gabapentinoid frequently prescribed for neuropathic pain, also increasingly identified as a drug for abuse. We describe a unique case of 31-year-old man presented with subacute neuro-psychiatric symptoms and a spectrum of movement disorders, suspicious of autoimmune encephalitis. Initial response to IV methylprednisolone followed by recurrence of symptoms strengthened our suspicion for autoimmune encephalitis. His autoimmune encephalitis workup was negative, however, his two MRIs showed parenchymal changes. The patient, finally, confessed to chronic pregabalin abuse. He recovered completely upon stopping pregabalin abuse and remained asymptomatic at follow-up. To the best of our knowledge, we are the first to describe parenchymal changes in MRI mimicking autoimmune encephalitis in a case of pregabalin abuse. Despite the limited number of reports of pregabalin abuse in India, it is time to consider restricting the pregabalin availability, in line with many Western countries. This is particularly relevant to India, where, one legitimate prescription can be used by many to buy medicines at multiple stores without any questions being asked by the pharmacists.
Perioperative Management of a Patient with Chin-On-Chest Deformity Presenting for Reconstructive Spine Surgery
Authors: Khandelwal Ankur , Sokhal Suman , Dube Surya K , Goyal Keshav , Singh Akanksha , Tandon Vivek , Phalak Manoj , Chaturvedi Arvind , Kale Shashank Sharad 
Published: December 2021

Abstract
Chin-on- chest deformity is not uncommon sequelae of ankylosing spondylitis. Apart from difficult airway, several other considerations might include co-existing cardio-respiratory embarrassment, osteoporotic bones, and neurological perturbations. We describe the successful anesthetic management of a case of chin-on-chest deformity with no access to midline neck structures and extremely difficult airway posted for corrective spine surgery.
Osteomalacic Myopathy in Children and Adolescents with Vitamin-D Deficiency
Authors: Sahni Suhalika S , Kakkar Shruti , Kumar Ruchika , Goraya Jatinder S 
Published: December 2021

Abstract

Background:
Osteomalacic myopathy secondary to vitamin-D deficiency is an under-recognized cause of muscle weakness in children and adolescents.

Aim:
To describe a cohort of children and adolescents with osteomalacic myopathy.

Settings and Design:
Pediatric neurology unit of a tertiary care hospital.

Methods and Material:
Charts of children and adolescents with osteomalacic myopathy were retrospectively reviewed for demographics, clinical presentation, laboratory investigations, and treatment response. Diagnosis of vitamin-D deficiency was made on the basis of a combination of clinical, biochemical, and radiographic findings. Response to treatment with vitamin-D confirmed vitamin-D deficiency as the cause of myopathic symptoms.

Results:
Twenty-six children—15 girls and 11 boys aged between 20 months and 19 years—with osteomalacic myopathy were identified. Fifteen (58%) children were between 10 years and 19 years of age. Twenty-one (81%) children presented with myopathic symptoms of progressive walking difficulty, with eventual loss of ambulation in six. Four children came to attention through hypocalcemic seizures. One nonambulatory child with cerebral palsy presented with loss of previously attained ability to roll over and sit. All children had proximal muscle weakness on examination. Fifteen (58%) children had clinical signs of rickets. All the children who underwent biochemical (n = 24) and radiographic (n = 16) investigations had results consistent with vitamin-D deficiency. Only in one child, the diagnosis of osteomalacic myopathy was made on the basis of clinical findings. Response to vitamin D was uniformly good.

Conclusions:
Vitamin-D deficiency should be considered in the differential diagnosis of proximal myopathy in children and adolescents.
Risk Factors, Recurrence and Short-Term Outcomes for Progressive Cerebral Infarction
Authors: Wang Yuanwei , Wang Ying , Du Li , Liu Ping , Fei Zhengdong 
Published: December 2021

Abstract

Background:
Only a few studies have investigated the risk factors for the prognosis of progressive cerebral infarction (PCI) and the relationship between PCI and cerebral infarction (CI) recurrence.

Objective:
The objective of this study is to analyze the risk factors for PCI and PCI prognosis and evaluate the relationship between PCI and CI recurrence, mortality, short-term outcomes.

Methods:
The retrospective study included 221 CI patients. PCI and non-PCI patients were divided into the observation (91) and control (130) groups, respectively. Patients' clinical data, including diabetes history, laboratory blood indices, National Institutes of Health Stroke Scale (NIHSS) scores at admission, and presence of carotid and intracranial artery stenoses, were retrospectively analyzed. Instances of CI recurrence, adverse short-term outcomes, and death within 1 year postanalysis were recorded.

Results:
Diabetes, homocysteine, NIHSS score at admission, fibrinogen, and intracranial artery stenosis were associated with PCI. Age, NIHSS score at admission, and pneumonia were associated with PCI prognosis. By 12-month follow-up, the mortality and adverse outcome rate in the observation group were significantly increased than those of the control group. There was no diference in CI recurrence rates between the groups. Adverse outcomes were associated with PCI, age, and homocysteine.

Conclusions:
PCI risk factors included diabetes, homocysteine, NIHSS score at admission, fibrinogen, and intracranial artery stenosis. The independent risk factors for PCI prognosis included age, high NIHSS score at admission, and pneumonia. PCI did not affect CI recurrence but may affect adverse short-term outcomes.
Predictive Factors of Postoperative Peritumoral Brain Edema after Meningioma Resection
Authors: Li Liang-Ming , Zheng Wen-Jian , Chen Ying-Zhi , Hu Zi-Hui , Liao Wei , Lin Qi-Chang , Zhu Yong-Hua , Huang Han-Tian , Lin Shao-Hua , Gong Jian 
Published: December 2021

Abstract

Background:
Postoperative peritumoral brain edema (PTBE) is the progressively exacerbating cerebral edema following meningiomas resection.

Objective:
The study aims to identify the predictive factors of postoperative PTBE.

Materials and Methods:
A retrospective study was conducted on the 117 cases of patients who underwent meningioma. The histopathological features of the tumors were re-assessed according to WHO 2016 classification. Clinical and pathohistological features were analyzed.

Results:
Thirteen patients (11.1%) were diagnosed having postoperative PTBE. Preoperative seizure (odds ratio [OR] = 6.125, P = 0.039) and histological prominent nucleoli (OR = 3.943, P = 0.039) were the independent risk factors for postoperative PTBE. Meningiomas with a parietal localization were more likely to develop postoperative PTBE (OR = 3.576, P = 0.054). Brain invasion and large tumor volume did not increase complication rate. Preoperative edema index was significantly higher in brain invasive meningiomas (3.0 ± 2.2 versus 1.8 ± 1.7, P = 0.001). Patients having moderate preoperative PTBE were prone to the complication (21.4% versus 7.9%, P = 0.100).

Conclusions:
Preoperative seizure were the predictive factors for postoperative PTBE. Careful venous protection during the operation may be helpful, especially for tumors locating in the parietal lobe. Prominent nucleoli observed in postoperative pathology should warrant surgeons' attention. Comprehensive perioperative management is essential for these patients.
Atlantoaxial and Subaxial Cervical Spinal Instability in Two Cases with Neurofibromatosis-Type 1
Authors: Goel Atul , Dandpat Saswat , Shah Abhidha , Bhambere Sagar , Darji Hardik 
Published: December 2021

Abstract
This is a report of two patients who were diagnosed to have NF-1. The patients had severe dystrophic soft tissue and bone changes leading to craniovertebral junction and subaxial cervical spinal instability and deformity. Both the patients underwent atlantoaxial and subaxial cervical spinal stabilization. No bone, soft tissue or tumor resection was done for decompression. Both patients had gratifying clinical recovery. Follow-up in both the patients is more than 12 months.
A Rare Case of Stroke in an Adolescent Violinist Due to Thoracic Outlet Syndrome
Authors: Kuril Sandeepkumar , Chopade Pramod R , Mandava Mamatha , Bhatia Sonal 
Published: December 2021

Abstract
Thoracic outlet syndrome (TOS), a rare condition, results from the compression of neurovascular structures traversing from the neck through the thoracic outlet into the axilla. It can develop from chronic repetitive activities of the upper extremities, commonly reported in athletes playing sports involving vigorous use of arms and shoulders. While symptoms of neurovascular compression can occur, stroke due to TOS in children is not commonly reported. We describe a rare case of a healthy 14-year-old boy, a competitive violinist, with acute limb ischemia from extensive occlusive thrombi involving several arteries in the right upper extremity as well as the right vertebral artery, which ultimately caused infarcts in the bilateral posterior circulation. The etiology was determined to be TOS leading to impingement of the right subclavian artery by a fused cervical rib aggravated by patient's prolonged violin practice. This case represents the first description of stroke from TOS in an adolescent violinist.
Embolectomy by SOLUMBRA Technique for Nontarget Intracranial Glue Migration— Complication and Bailout after Percutaneous Embolization of Orbital Meningioma
Authors: Chauhan Richa Singh , Prasad Chandrajit , Siddiqui Shahyan M , Srinivas Dwarakanath 
Published: December 2021

Abstract
Presurgical devascularization of neoplasms of the head and neck can be achieved by endovascular as well as direct percutaneous embolization techniques. We report a case of percutaneous glue embolization of an orbital meningioma, complicated by delayed acute stroke due to the distal migration of polymerized glue in the left middle cerebral artery. To the best of our knowledge, this is the first report to discuss the percutaneous embolization of orbital meningioma complicated by stroke due to intracranial glue migration.
Machine Learning Techniques for the Diagnosis of Attention-Deficit/Hyperactivity Disorder from Magnetic Resonance Imaging
Authors: Periyasamy R , Vibashan VS , Varghese George T , Aleem MA 
Published: December 2021

Abstract

Background:
Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental disease commonly seen in children and it is diagnosed via extensive interview procedures, behavioral studies, third-party observations, and comprehensive personal history. ADHD causes regional atrophy in brain regions and alters the pattern of functional brain connectivity networks. Automated/computerized methods based on magnetic resonance imaging (MRI) can replace subjective methods for the identification of ADHD.

Objectives:
The aim of this study was to analyze various machine-learning algorithms for ADHD by feeding in vital input features extracted from functional brain connectivity and different existing methods and to review factors crucial for the diagnosis of ADHD.

Methods:
This paper is a concise review of machine learning methods for the diagnosis of ADHD from MRI. Techniques for feature extraction, dimensionality reduction/feature selection, and classification, employed in the computerized techniques for the diagnosis of ADHD from MRI and the accuracy of classification offered by the individual methods, are focussed on the review.

Conclusions:
Machine learning algorithms with features of functional brain connectivity networks as input, with hierarchical sparse feature elimination, exhibits the highest accuracy. Augmentation of the behavioral features does not contribute much to increased accuracy. The level of accuracy offered by the frameworks meant for the computer-aided diagnosis of ADHD, available in the literature, does not justify their feasibility in clinical practice. Computerized methods that exploit highly specific biomarkers of ADHD like brain iron concentration in Globus Pallidus, Putamen, Caudate nucleus, and thalamus as features are not available.
Effect of Low-Dose Naltrexone on Egyptian Children with Intractable Epilepsy
Authors: Abokrysha Noha T. , Kishk Nirmeen A. , Nawito Amani M. , Mounir Nesma 
Published: December 2021

Abstract
Epilepsy is a chronic neurological disorder affecting 50 million patients worldwide, in need of continuous treatment, while 30% of them are refractory to treatment. Despite multiple antiepileptic drugs are available for the treatment of epilepsy, still refractory epilepsy especially in children represents a social burden in developing countries. Low-dose naltrexone (LDN) has been proposed as an immune modulator in multiple diseases and proved benefit especially in diseases with immune dysregulation. The purpose of this study is to demonstrate the effect of LDN in the treatment of children with intractable epilepsy and discuss its potential role in epileptogenesis process.
Far Lateral Craniotomy for Obliteration of High-Risk Craniocervical Junction Arteriovenous Fistula
Authors: Agnoletto Guilherme J , Fredrickson Vance L , Hollon Todd C , Couldwell William T 
Published: December 2021

Abstract

Background and Introduction:
Dural arteriovenous fistulas (dAVFs) are a rare pathology with a clinical presentation related to their anatomical location. Craniocervical junction (CCJ) dAVFs are challenging to treat given the delicate structures that surround the CCJ. Endovascular treatment has evolved significantly in the past decade, but open microsurgery remains an invaluable tool for this pathology.

Objective:
To demonstrate the step-by-step elements of the far lateral approach for microsurgical ligation of CCJ dAVF.

Surgical Technique:
A retroauricular incision is created, extending down the neck, and the suboccipital triangle muscles are dissected, exposing the posterior arch of C1. The vertebral artery (VA), as well as its entrance point in the dura, is also dissected and exposed. Next, a C1 hemilaminectomy is performed, followed by a suboccipital craniectomy and drilling of the posteromedial portion of the condyle. The dura is opened behind the VA entrance in the dura, and the intradural VA is exposed. Once the fistula is identified, a temporary clip is placed on the draining vein. Indocyanine green video angiography is used to confirm that there is no further connection; the clip is then removed and the fistula obliterated. The dura is closed in a watertight fashion with a fat bolster to prevent a pseudomeningocele.

Results:
Postoperative angiogram showed complete resolution of the pathology. The patient was discharged neurologically intact on postoperative day 4.

Conclusions:
Microsurgical obliteration of CCJ dAVFs can be achieved safely and efficiently through a far lateral approach.
Gravity Assisted Retraction Less Occipito Transtentorial and Trans-Splenial Approach for Posterior Third Ventricular Dermoid
Authors: Sardhara Jayesh , Kumar Ashutosh , Srivastava Arun K , Nangarwal Bhawan , Behari Sanjay 
Published: December 2021

Abstract

Background and Introduction:
A dermoid is an inclusion cyst. Its presence in the posterior third ventricle is highly infrequent. It usually compresses rather than infiltrates the posterior third ventricle's anatomical structures due to a well-defined capsule. Hence, the surgical anatomy in these tumors is less distorted. The approach to the posterior third ventricular tumors depends upon their relation to the galenic venous complex.

Objective:
This video abstract presents a case of the posterior third ventricular dermoid operated by gravity-assisted retraction less occipito transtentorial combined with the trans-splenial approach.

Surgical Technique:
A 36-year-old gentleman presented with a headache without any neurological deficits; the magnetic resonance imaging (MRI) revealed a well-defined heterogeneous lesion in the posterior third ventricular region. It was mainly toward the right side, just beneath the splenium, pushing the galenic venous system downward. This made the occipital transtentorial approach favorable as it required the least vessel handling. A right parieto-occipital craniotomy was performed. The patient was placed in a lateral semi-prone position with the head slightly rotated toward the right side with a slight neck extension. This allowed the right occipital lobe to fall away from the Falco-tentorial junction. With sharp dissection, an inter-Rosenthal corridor was made. But as the tumor was higher up in the posterior third ventricle, it was modified to another trans-splenial corridor. Near-total excision was achieved with a thin capsule left attached to the vein of Galen. The capsule was thick, filled with a cheesy white material, and a calcified sebaceous lump within. The postoperative scan showed no residual tumor.

Results:
The patient had improvement in the headache. There were no field cuts. The histopathology was suggestive of a dermoid cyst.

Conclusions:
Dermoid cysts of the posterior third ventricular region are rare, and judicious surgical decisions result in better outcomes.
Correlation of Positive End-Expiratory and Intracranial Pressure Using the Ultrasonographic-Guided Measurement of Optic Nerve Sheath Diameter in Traumatic Brain Injury Patients
Authors: Gupta Neha , Singh Vipin K , Jafa Shobhna 
Published: December 2021

Abstract

Background:
In brain injury patients, positive end-expiratory pressure (PEEP) may potentially increase the intracranial pressure (ICP). ICP can be noninvasively assessed from the sonographic measurement of the optic nerve sheath diameter (ONSD). Herein, we aim to evaluate the association between PEEP and ICP via measuring ONSD in traumatic brain injury (TBI) patients.

Methods:
TBI patients with age ≥18 years, severe brain injury (GCS 8 or less), receiving mechanical ventilation, initial PEEP ≤4 mmHg and no history of severe cardiopulmonary disease were included in this study. Patients with intracranial hypertension (defined as ICP >20 mmHg) and already receiving PEEP >15 cm H2O at enrollment were excluded from the study. ONSD measurement was performed when hemodynamic parameters were most stable. Variables included central venous pressure, invasive blood pressure, heart rate, saturation, and ventilator parameters.

Results:
The ONSD and ICP did not increase significantly while PEEP increased from 0–5 cm and 5–10 cm H2O. However, ONSD and ICP significantly increased when PEEP increased from 10–15 cm H2O. There was no significant difference noted while comparing measurements of optic nerve sheath (ONS) diameter in both eyes at all PEEP values in cases as well as control patients. Mean arterial pressure (MAP) decreased with an increase in PEEP value. Highly significant decrease occurred in MAP change from PEEP 10–15 in cases (P < 0.001) and control (P < 0.001).

Conclusions:
The PEEP up to 10 cm H2O can be safely applied in patients with TBI. In addition, the increment of PEEP might further increase the oxygenation, at the cost of ICP accentuation.
Feasibility of the Transseptal Approach for Mapping and Ablation in Patients with Ventricular Aneurysm-Related Ventricular Tachycardia with a Steerable Sheath
Authors: Chen Lian , Tang Min , Ren Xiaoqing , Fang Pihua , Zhang Jingtao , Feng Tianjie , Zhai Zhengqin , Dong Xiaonan , Zhang Shu 
Published: December 2021

Background:
A retrograde transaortic access might be limited in mapping and ablation for some left ventricular (LV) arrhythmias. We examined the feasibility and safety of a transseptal approach for catheter ablation of LV aneurysm (LVA)-related ischemic ventricular tachycardia (VT).

Subjects and Methods:
Five consecutive patients with postinfarction LVA-related VT were selected for catheter ablation at Fuwai Hospital from April 2011 to October 2015 in this retrospective study. After a routine transaortic LV-mapping approach was failed, a transseptal approach with a steerable sheath was performed in all these cases. The study was approved by the Ethics Committee of Fuwai Cardiovascular Hospital (approval No. 2016-768) on May 24, 2016.

Results:
In these five patients, four had LVAs located in the LV apical area, and one in the septum. Acute ablation successes were all failed to achieve through the transaortic route. Two were due to aortic stenosis and tortuous peripheral arteries and the others were due to failure to target the effective sites. While all ablation procedures succeeded through the sequent transseptal approach with a steerable sheath, and no major complications related to the transseptal approach were reported. During the 12-month (10–12 months) follow-up, no electrical storm or episode of VT was documented. One VT recurrence occurred, yet acute success was obtained again through the transseptal approach.

Conclusions:
Transseptal approach appears a feasible, safe, and effective method in catheter ablation for VT with LVA and could be considered as an elective approach.
Predictive factors for high-flow nasal cannula failure in acute hypoxemic respiratory failure in an intensive care unit
Authors: Lun Chung-Tat , Leung Chi-Kin , Shum Hoi-Ping , So Sheung-On 
Published: December 2021

Background and Objective:
High-flow nasal cannula (HFNC), a relatively new technique in acute hypoxemic respiratory failure (AHRF), is gaining popularity in intensive care units (ICUs). Our study aims to identify the predictive factors for failure of HFNC.

Materials and Methods:
This is a 5-year retrospective cohort study in patients with AHRF using HFNC in an ICU of a regional hospital in Hong Kong. The primary outcome is to identify the predictive factors for failure of HFNC which is defined as escalation of treatment to noninvasive ventilation, mechanical ventilation, extracorporeal membrane oxygenation, or death.

Results:
Of the 124 ICU patients with AHRF, 69 (55.65%) failed in the use of HFNC. The patients failing HFNC had higher Acute physiology and Chronic Health Evaluation IV scores, lower Glasgow Coma Scale scores, lower platelet counts and serum sodium levels upon ICU admission, and higher pH on day of HFNC commencement. They had higher respiratory rates before HFNC and higher heart rates before and 1 h after HFNC. The respiratory rate-oxygenation (ROX) index which is defined as a ratio of SpO2/FiO2 to respiratory rate was significantly lower in the failure group 1 h and 12 h after HFNC. By multivariate binary logistic regression, failure of HFNC is associated with lower ROX index at 12 h after HFNC.

Conclusion:
ROX index at 12 h serves as a valuable tool to monitor the responsiveness to HFNC treatment. Close monitoring is required to identify patient failing using HFNC.