bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Course of Post-Traumatic Amnesia: Three Little Words
Authors: Schwartz M.L. , Carruth F. , Binns M.A. , Brandys C. , Moulton R. , Snow W.G. , Stuss D.T. 
Published: February 2016

ABSTRACT:Objective:To provide a simple means of ”real time“ recognition of emergence from post-traumatic amnesia (PTA).Methods:Ninety-one patients with traumatic brain injury (PBI); 53 minor (GCS 13-15), 19 moderate (GCS 9-12), 18 severe (GCS 3-8). Twenty-seven control subjects treated at two regional trauma units for their acute phase and followed in a hospital-based research institute were studied prospectively. Subjects were examined repeatedly following injury with the Galveston Orientation and Amnesia Test (GOAT) and tests of their ability to learn and retain new information. Word triplets balanced for concreteness and frequency were presented. Immediate and 24-hour recall were tested. If 24-hour recall was imperfect, recognition was tested by presenting the 3 target words and 6 distracters. The target words were then re-presented and recall was tested the next day. The time intervals to first perfect recognition and first free perfect recall were compared with the patients' first GOAT score of 75 or greater on 2 successive days. Simple line drawings of common objects were also presented to the subjects using an identical paradigm. The outcome measures were GOAT, 3-word recognition and recall, 3 picture recognition and recall.Results:For all categories of head injury severity, the median interval to perfect free recall of words followed the achievement GOAT criterion by a significant interval. The mean GOAT scores for perfect 3-word recall and recognition corresponding to minor, moderate and severe injuries were 97, 90 and 88, and 97, 76 and 68 respectively. The recognition and recall of pictures preceded the recognition and recall of words by approximately 1 day.Conclusions:The orientation measures of the GOAT that contain material that the patient knew prior to injury obscure the determination of recovery of continuous memory and should be tested separately. Three-word recall which is simpler to administer than the GOAT is a more reliable measure of emergence from PTA. For patients who are dysphasic or who do not share a common language with the examiner, 3-picture recognition and recall may substitute for word recognition and recall.
Cost Analysis of Methylprednisolone Treatment of Multiple Sclerosis Patients
Authors: Robson Lynda S. , Bain Charlene , Beck Shann , Guthrie Suzanne , Coyte Peter C. , O'Connor Paul 
Published: February 2016

ABSTRACT:Background:Intravenous methylprednisolone (IVMP) is the treatment of choice for multiple sclerosis (MS) patients undergoing acute exacerbation of disease symptoms and yet its cost has not been accurately determined. Determination of this cost in different settings is also pertinent to consideration of cost-saving alternatives to in-patient treatment.Methods:Cost analysis from the point of view of the health care system of IVMP treatment of MS patients receiving treatment in association with a selected Toronto teaching hospital in fiscal year 1994/95 was carried out. Costs of any concurrent treatments were excluded.Results:Total cost for 92 patients, based on a 4 dose regime, was estimated to be $78,527. The the cost per patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients of the MS Clinic (OP) and $774.21 for patients whose treatment was initiated in the Clinic, but completed in the home (HC). Sensitivity analyses indicated: 1) IP treatment was in all cases more expensive than that of OP or HC; 2) the cost savings of OP vs. HC was sensitive to assumptions made regarding Clinic overhead, Clinic nursing costs and Home Care Program overhead.Conclusion:Alternatives to in-patient care must be considered carefully. In this study, both out-patient and in-home treatment were cost-saving alternatives to in-patient treatment, but large differences in the cost of hospital out-patient vs. in-home care could not be demonstrated.
Pathological Laughter Following Intravenous Sodium Valproate
Authors: Jacob P.C. , Pratap Chand R. 
Published: February 2016

ABSTRACT:Background:Pathological laughter can be a sign of epilepsy, psychiatric illness, effect of toxins or psychotropic drugs or of structural brain disease.Method:Case Studies.Result:Two patients developed inappropriate uncontrollable laughter following intravenous sodium valproate for treatment of epilepsy.Conclusion:Pathological laughter can be a side effect of intravenous sodium valproate.
Electrophysiological Respiratory Studies in the Critical Care Unit
Authors: Zifko Udo A. 
Published: February 2016

AbstractRespiratory electrophysiological studies are useful in the investigation and monitoring of respiratory failure. Phrenic nerve conduction studies and needle electromyography of the diaphragm are invaluable in establishing the diagnosis, determining the severity, and following the progression of peripheral respiratory muscle dysfunction. In addition to these established methods, repetitive phrenic nerve stimulation is of diagnostic value in patients with neuromuscular transmission defects and dyspnea. The diagnosis of impaired central respiratory drive can often be accomplished by the newly-developed techniques of transcortical magnetic stimulation of the motor cortex with recording of the diaphragm and phrenic nerve somatosensory evoked potentials. These studies are of particular value in critically ill patients where both the central and peripheral lesions may impair respiration.
Methods of Testing Neuromuscular Transmission in the Intensive Care Unit
Authors: Grand'Maison François 
Published: February 2016

AbstractAll disorders of neuromuscular transmission (NMT) may cause ventilatory failure, albeit rarely. Respiratory muscle weakness is occasionally the presenting feature of myasthenia gravis (MG), the Lambert-Eaton myasthenic syndrome (LEMS), hypermagnesemia and botulism. Chronic MG, congenital myasthenic syndromes and LEMS may be acutely exacerbated by various intercurrent conditions and by drugs which interfere with NMT. Finally, in the ICU, difficulty in weaning from the ventilator may be caused by prolonged use of neuromuscular blocking agents. Electrophysiological studies of NMT disorders in the intensive care unit have rarely been reported. Nevertheless, the available data indicates that the electrodiagnosis of severe NMT disorders can be misleading. With severe NMT defects, the electrophysiological distinction between post-synaptic and pre-synaptic disorders is blurred and the differential diagnosis with myopathies may be difficult. A clinically suspected NMT disorder should therefore not be ruled out when electrodiagnosis fails to demonstrate the expected abnormalities.
Myopathies in the Intensive Care Unit
Authors: Zochodne Douglas 
Published: February 2016

AbstractMyopathies that occur in the intensive care unit can be divided into preexisting myopathies or newly acquired myopathies that develop in the intensive care unit. Myotonic dystrophy is an example of a preexisting myopathy that may render patients susceptible to acute respiratory failure following surgical procedures and anaesthesia. A group of myopathies that develop within the intensive care unit have been labelled acute necrotizing myopathy of intensive care, thick filament myopathy and acute steroid myopathy. Corticosteroids and nondepolarizing muscle blocking agents may play a role in their development.
Descriptive Epidemiology of Parkinson’s Disease through Proxy Measures
Authors: Strickland Daniel , Bertoni John M. , Pfeiffer Ronald F. 
Published: February 2016

AbstractBackground and Objective: In preparation for analytic study we undertook to describe areas of relative excess and deficit of Parkinson’s Disease (PD) in Nebraska and tested two methodologic tools for inexpensive assessment of descriptive epidemiology of PD. Methods: In lieu of large-scale population screening and diagnosis, we obtained sales information of anti-PD drugs in the state in 1988 – 1990 as well as listings of all people dying from 1984 to 1993 who had Parkinson’s Disease mentioned anywhere on their death certificate. The anti-PD drug sales data are intended as a proxy for prevalence, while the death certificate data are intended as a proxy for incidence. Results: Sales divided by population over age 54 indicates where anti-PD drug sales differ from expected. We found high correlation of drug sales rates with several farming exposures. Age-adjusted death rates, however, showed a low degree of association with sales or farming variables. This may be attributable to differences in death certificate completion or in underlying incidence versus prevalence. Conclusions: These techniques provide a useful tool for delineating possible differences in incidence and prevalence. While not as accurate as full community survey with expert diagnosis, they are not as expensive, and can be followed by local cluster investigations and individual-level etiologic studies to test hypotheses resulting from the initial study.
Herbert Jasper: an Appreciation and a Tribute on His 90th Birthday
Authors: Andermann Frederick 
Published: February 2016

It is particularly fitting that at this reception of members of the Canadian Neurological and Clinical Neurophysiologists Societies at the American Academy of Neurology we should honour Dr. Herbert Jasper. He is, at the age of 90, a living legend in the neurosciences. It is a rare opportunity for the young people who have followed him to meet a pioneer of his generation, let alone somebody who continues to this day to exercise his wise counsel and his extraordinary grasp of the working of the human brain.Herbert Jasper, like Wilder Penfield, was born in the west of the United States, and, like his friend and colleague, became a Canadian and a founder of Canadian Neuroscience.Jasper started his career as a psychologist of physiological persuasion and studied with Lapique who is remembered for his studies on chronaxie, in Paris. He became aware of Berger’s writings on the electroencephalogram and realized early the enormous potential of being able to record the electrical activity generated by the human brain. In the 30s, two schools of epilepsy developed in North America: the medical with William Lennox in Boston, and the surgical with Wilder Penfield in Montreal.
Localizing Muscles for Botulinum Toxin Treatment of Focal Hand Dystonia
Authors: Geenen C. , Consky E. , Ashby P. 
Published: February 2016

AbstractBackground: There is currently no consensus on the best way to localize muscles in the forearm for botulinum toxin (BTX) injection. We devised a study to compare electromyography (EMG) with local stimulation through a cannula for localizing forearm muscles for botulinum toxin (BTX) injection, and for predicting the risk of unwanted weakness in non-target muscles. Methods: In 12 patients with focal hand dystonia a single “target” muscle, determined by clinical examination to contribute most to the dystonic hand posture, was selected for botulinum toxin injection. The patients were randomized into 2 treatment groups, one in which the target muscle was localized by recording the EMG signals during voluntary contractions (8 patients) and the other in which the target muscle was localized by local electrical stimulation (4 patients). The target muscle was then injected with a standardized dose of BTX. Results: At follow-up 3 weeks after BTX injection the target muscle was weakened in 7/12 patients (4/8 of the EMG group, and 3/4 of the stimulation group). Additional non-injected muscles, adjacent to the target muscle, were weakened in 5 of these 7 patients, presumably from diffusion of the toxin. Conclusions: Localization by stimulation is probably at least as good as EMG. Each technique has certain advantages. Weakness of “non-target” muscles was not consistently predicted by either EMG or stimulation suggesting that BTX diffuses farther than the volume conduction of EMG signals or the spread of effective stimulus current.
Focal Midbrain Glioma: Long Term Survival in a Cohort of 16 Patients and the Implications for Management
Authors: Hamilton Mark G. , Lauryssen Carl , Hagen Neil 
Published: February 2016

AbstractBackground: Focal gliomas involving the midbrain tectum and tegmentum have been identified as having a better prognosis than diffuse tumors affecting the brain stem. However, only limited information is available concerning treatment effectiveness and long term outcome for these patients. Methods: A retrospective, population-based cancer registry survey was performed to assess the clinical features and treatment courses of patients with focal midbrain tumors. Results: Sixteen patients with midbrain gliomas were identified; eight had tectal gliomas and eight tegmental gliomas. Thirteen patients presented with symptoms related to hydrocephalus, and 12 required a ventriculoperitoneal shunt. Seven patients underwent surgery directed at the tumor. Eight patients underwent initial radiation therapy and none had initial chemotherapy. One patient diagnosed at age 18 months had a rapidly growing tumor after 14 months of follow up which has responded to chemotherapy. The mean survival of this patient population was 84 months (range 3-280 months) after diagnosis, with only one tumor related death occurring (280 months after diagnosis). Survival was not affected by tumor location within the midbrain (tegmental or tectal) or by whether radiation therapy was or was not administered. Conclusions: Patients with focal midbrain gliomas require symptom control aimed at treatment of hydrocephalus, or mass effect from the tumor. However the extended survival of this population suggests that routine aggressive surgical debulking is often not required. Furthermore, the routine use of radiation therapy or chemotherapy for all such patients is questioned.
Functional MRI Localization of Language in a 9-Year-Old Child
Authors: Benson R.R. , Logan W.J. , Cosgrove G.R. , Cole A.J. , Jiang H. , LeSueur L.L. , Buchbinder B.R. , Rosen B.R. , Caviness V.S. 
Published: February 2016

AbstractBackground: Localizing critical brain functions such as language in children is difficult and generally requires invasive techniques. Recently sensory, motor and language functions in adults have been mapped to specific brain locations using functional imaging techniques. Of these techniques, functional MRI (fMRI) is the least invasive and has the highest spatial and temporal resolution. Its use in adults is well documented but application to children has not been as well described. In the present study lateralization and localization of language was evaluated with fMRI prior to epilepsy surgery in a nine-year-old male with complex partial seizures, attentional difficulty and decreased verbal proficiency. Methods: Two language paradigms well studied in adults (read, verb generation) and two additional language paradigms (antonym generation, letter fluency) were studied using whole brain fMRI after stimulus items and timing were adjusted to achieve the desired performance level during imaging. The patient was also conditioned to the magnet environment prior to imaging. Results: Word reading and letter fluency tasks produced lateralized and localized activation similar to that seen in adults. The patient had no language deficits following an anterior 2/3 dominant temporal lobe resection. Conclusions: With modifications of protocols such as those detailed in this report, this non-invasive method for localizing language function is feasible for the presurgical evaluation of children as well being applicable for a variety of developmental language issues.
Bilateral Hypoglossal Nerve Injury with Occipital Condylar Fracture
Authors: Lam Cornelius H. , Stratford Joseph 
Published: February 2016

ABSTRACT:Background: A 20-year-old woman with a right occipital condylar fracture and bilateral hypoglossal nerve injury is presented. Only 17 cases of condylar fracture have been reported in the literature. Methods: The patient was evaluated with plain films, coronal and axial cut CT, and MRI. Results: MRI showed a severely distorted but otherwise normal medulla and a displaced condylar bone fragment. Conclusion: Condylar fracture may cause twelfth nerve palsy by injuring the central or peripheral nerve.
Historical Neurology and Neurosurgery George A. Savoy? Visionary Benefactor of Canadians with Epilepsy, and the History of the Savoy Foundation for Epilepsy
Authors: Rémillard C.M. , Zifkin B.G. , Sherwin A. , Feindel W. 
Published: February 2016

ABSTRACT:George A. Savoy was born in Cohoes, New York, in 1873. He left the U.S.A. in 1921 to manage the Canadian branch of a large manufacturer of ledgers and looseleaf registers. This company was asked to supply Professor Jasper’s laboratory with rolls of plain unlined paper and it was George Savoy who later developed fanfolded and lined EEG paper, which was first used at the Montreal Neurological Institute. He also had personal contacts with Wilder Penfield concerning their mutual interest in the needs of patients with epilepsy. He was a successful industrialist involved with several charitable organizations funding programmes for people with epilepsy. He was opposed to the sectarianism then prevalent in Quebec, which was unfamiliar to him, and in reaction built his own institution, Dieppe House, a home for people with epilepsy, later renamed «Foyer Savoy». It was to operate without regard to race, language or religion. In 1971, his son Harold and other generous donors decided to create a foundation to support research in epilepsy. The Foyer Savoy was sold in 1988 and the proceeds used to increase the endowment of the foundation. His grandson George M. Savoy is the current president. The fourth generation is also represented by Caroline Savoy, daughter of the president, who joined the board of directors in 1992. The foundation will distribute from $300,000 to $400,000 yearly to researchers from many different countries working in the field of epilepsy in universities and hospitals throughout Canada.
Protection of the Brain After Aneurysmal Rupture – Richardson Lecture
Authors: Weir Bryce 
Published: February 2016

AbstractThe majority of patients survive the first dangerous hours after an aneurysmal rupture. However, many subsequently succumb as a result of a variety of lethal complications. The most important of these develop as sequelae of the initial ischemia, rebleeding and the delayed onset of vasospasm. Some of these deleterious cascades can be aborted. Since the delayed complications such as vasospastic infarction can be accurately predicted, this is one of rare “strokes” that can have pharmacological pre-treatment. The natural history of rebleeding and vasospasm are described as well as their effects on blood flow, oxygen delivery and metabolism. Strategies to ameliorate acute and delayed ischemia and hypoxia are discussed. Finally, potential pharmacotherapies are detailed.
Ruptured and Unruptured Intracranial Aneurysms – Surgical Outcome
Authors: Dix Gary A. , Gordon William , Kaufmann Anthony M. , Sutherland Ian S. , Sutherland Garnette R. 
Published: February 2016

AbstractBackgroundThe treatment of unruptured, intracranial aneurysms has been the topic of debate. Although recent studies have advocated surgical intervention for unruptured aneurysms, the risk of such treatment in comparison to outcome from ruptured aneurysms has not been established.MethodThis retrospective study examines the outcome of 134 patients with 179 ruptured and unruptured intracranial, saccular aneurysms treated by a single surgeon.ResultsOf the 98 ruptured aneurysms where early surgical intervention was undertaken (less than 48 hours post hemorrhage), 70 had an excellent outcome, 13 were good, four were moderate, two poor and nine patients died postoperatively. Outcome assessment in these cases was correlated to preoperative neurological status. Patients who presented with unruptured aneurysms fell into two categories: symptomatic and asymptomatic. Seven incidental, asymptomatic aneurysms were clipped concurrently to the surgical isolation of the culprit lesion following subarachnoid hemorrhage without influencing outcome, whilst, for varying reasons, eight unruptured aneurysms were not operated upon. Of the remaining 66 surgically treated, unruptured aneurysms, 64 had an excellent postoperative result, one was good (persisting right incomplete third nerve palsy) and one was moderate (left hemiparesis). Thirteen of these aneurysms were symptomatic, whilst 21 were asymptomatic, multiple aneurysms requiring secondary elective repair and 32 were true incidental aneurysms.ConclusionUnruptured aneurysms less than 25 mm in size may be safely, surgically treated relative to the expected natural history and, certainly, with less risk than operative intervention upon ruptured cerebral aneurysms.
Paradoxical Autonomic Response to Procyclidine in the Neuroleptic Malignant Syndrome
Authors: Balzan Martin V. 
Published: February 2016

AbstractBackgroundNeuroleptic Malignant Syndrome (NMS) is an adverse reaction to dopamine receptor antagonists, characterised by hyperpyrexia, extrapyramidal rigidity and impaired autonomic function. It might result from central dopamine receptor blockade that causes severe muscle contraction.MethodCase Study.ResultsHigh dose intravenous therapy with the anticholinergic drug, procyclidine hydrochloride, temporarily diminished the muscle rigidity and reversed most of the autonomic features in a patient with NMS occurring after a single intramuscular dose of the dopamine antagonist metoclopramide. Paradoxically, however, the heart rate decreased and bowel movements increased with this atropine-like drug.ConclusionSince the degree of tachypnoea, tachycardia, and bowel hypotonia closely paralleled the severity of the muscle rigidity, it is suggested that these autonomic features of NMS result from sustained muscle contraction rather than a direct effect of neuroleptic drugs on the central nervous system.
Huntington’s Disease: Recent Advances in Diagnosis and Management
Authors: Furtado Sarah , Suchowersky Oksana 
Published: February 2016

ABSTRACT:Huntington’s Disease (HD) is a progressive degenerative disorder of the central nervous system inherited as an autosomal dominant trait. Clinically, the disorder is characterized by choreoathetosis (with age of onset typically in the late thirties or early forties) and neuropsychiatric disturbance. The striatum is particularly vulnerable to the degenerative disease process, with selective loss of medium spiny neurons and decreased levels of associated neurotransmitters, including substance P, GABA, met-enkephalin and dynorphin. Although the underlying pathophysiology is unknown, recent theories concerning pathogenesis have involved mitochondrial abnormalities and excitotoxin-mediated damage. The gene for HD has recently been discovered and characterized as an unstable CAG trinucleotide repeat sequence on the short arm of chromosome 4 (now known as IT 15). The direct test now available for the HD gene has facilitated disease diagnosis, particularly for those with unclear family history or chorea of uncertain origin; presymptomatic testing is also available. Management of affected individuals is unsatisfactory as only symptomatic control is available. However, as the effect of the genetic abnormality may soon be known, specific treatment of the disorder may become available in the near future.