bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnetic Resonance Spectroscopy Guided Brain Tumor Resection: Differentiation Between Recurrent Glioma and Radiation Change in Two Diagnostically Difficult Cases
Authors: Preul Mark C. , Leblanc Richard , Caramanos Zografos , Kasrai Reza , Narayanan Sridar , Arnold Douglas L. 
Published: February 2016

ABSTRACT:Background:It is often difficult to differentiate a recurrent glioma from the effects of post-operative radiotherapy by means of conventional neurodiagnostic imaging. Proton magnetic resonance spectroscopic imaging (1H-MRSI), that allowsin vivomeasurements of the concentration of brain metabolites such as choline-containing phospholipids (Cho), may providein vivobiochemical information helpful in distinguishing areas of tumor recurrence from areas of radiation effect.Patients and Methods:Two patients who had undergone resection and post-operative radiotherapy for a cerebral glioma became newly symptomatic. Computed tomographic (CT) and magnetic resonance imaging (MRI) performed after the intravenous infusion of contrast material, and in one case, [18F] fluorodeoxyglucose positron emission tomography (PET), could not differentiate between the possibilities of recurrent glioma and radiation effect. The patients underwent1H-MRSI prior to reoperation and the1H-MRSI results were compared to histological findings originating from the same locations.Results:A high Cho signal measured by1H-MRSI was seen in areas of histologicallyproven dense tumor recurrence, while low Cho signal was present where radiation changes predominated.Conclusions:The differentiation between the recurrence of a cerebral glioma and the effects of post-operative irradiation was achieved using1H-MRSI in these two patients whose conventional neurodiagnostic imaging was equivocal for such a distinction. Where these two conditions are present, metabolite images from1H-MRSI, such as that based on Cho, can be co-registered with other imaging modalities such as MRI and may also be integrated with functional MRI or functional PET within a multimodal imaging-guided surgical navigation system to assure maximal resection of recurrent tumor while minimizing the risk of added neurological damage.
Severe Tension Pneumocephalus Complicating Frontal Sinus Osteoma
Authors: Marras L.C. , Kalaparambath T.P. , Black S.E. , Rowed D.W. 
Published: February 2016

ABSTRACT:Background:Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life-threatening condition which can complicate craniofacial surgery, trauma, or cranial tumor. It presents as an acute or subacute expanding mass lesion.Case Report:We present a case of a 40-year-old male who developed tension pneumocephalus as a consequence of a previously detected but untreated frontal sinus osteoma. Despite prompt decompression and repair of the fistulous connection between the sinus and the intracranial compartment, the patient suffered permanent frontal lobe damage with significant neurocognitive sequelae and seizures.Conclusions:This case illustrates that tension pneumocephalus can be a dangerous entity with potential for early mortality and long-term morbidity. We recommend, therefore, early treatment and close follow up of destructive lesions involving the posterior frontal sinus wall.
Outcome Evaluation of Gabapentin as Add-on Therapy for Partial Seizures
Authors:   on behalf of the "NEON" Study Investigators Group
Published: February 2016

ABSTRACT:Objective:The safety, tolerability, efficacy, and impact on quality of life of gabapentin (Neurontin®) as adjunctive therapy to carbamazepine (CBZ) and/or phenytoin (PHT) was assessed in epileptic patients with partial seizures.Methods:NEON (Neurontin Evaluation of Outcomes in Neurological Practice) was an open-label, prospective, multicentre study conducted in patients on a stable dose of CBZ and/or PHT and experiencing an average of up to 4 complex partial seizures with or without secondary generalization per month, with no seizure-free months. The treatment lasted 20 weeks. Gabapentin was started at 400 mg/day and was individually titrated to effective tolerable dose up to 2400 mg/day. Quality of life was evaluated using the QOLIE-10 questionnaire.Results:A total of 141 patients were enrolled at 36 sites; 114 patients were evaluable for efficacy analyses. The mean maintenance dose of gabapentin was 1600 mg/day (range = 300-3200). A decrease of 50% or more in frequency of complex partial + secondarily generalized seizures was observed in 81 (71 %) patients (p = 0.0001). Fifty two (46%) patients were seizure-free during the last 8 weeks of treatment. A significant improvement (p < 0.05) was observed in 5 of the 10 questions of the QOLIE-10, as well as in the composite QOL score (p = 0.0002). The most frequent adverse events included somnolence (16%), dizziness (9%), and asthenia (6%). Twenty-five (18%) patients prematurely discontinued the study, 16 (11%) of them due to adverse events.Conclusion:This study indicates that treatment with gabapentin as adjunctive therapy to standard antiepileptic drugs in this group of patients not only provides significant improvement in seizure control, but also has a positive impact on quality of life. The clinical benefits in efficacy, safety and tolerability demonstrated at 20 weeks are sustained, and no tolerance develops with gabapentin in longer term use.
Respiratory Muscle Training in Patients With Moderate to Severe Myasthenia Gravis
Authors: Weiner Paltiel , Gross Ditza , Meiner Zeev , Ganem Rushrash , Weiner Margalit , Zamir Down , Rabner Marinella 
Published: February 2016

ABSTRACT:Background:Myasthenia gravis (MG) is a specific autoimmune disease characterized by weakness and fatigue. MG may affect also the respiratory muscles causing symptoms that may vary from dyspnea on severe exertion to dyspnea at rest. This study was undertaken in order to determine the effects of respiratory muscle training on respiratory muscle performance, spirometry data and the grade of dyspnea in patients with moderate to severe generalized MG.Methods:Eighteen patients with MG were studied and divided into 2 groups: Group A included 10 patients (3 males and 7 females aged 29-68) with moderate MG, and Group B that included 8 patients (5 males and 3 females aged 21-74) with severe MG. Patients in Group A received both inspiratory and expiratory muscle training for 1/2 h/day, 6 times a week, for 3 months, while patients in Group B followed the same protocol but had inspiratory muscle training only.Results:Mean PImax increased significantly from 56.6 ± 3.9 to 87.0 ± 5.8 cm H20 (p < 0.001) in Group A, and from 28.9 ± 5.9 to 45.5 ± 6.7 cm H20 (p < 0.005) in Group B. The mean PEmax also increased significantly in patients in Group A, but remained unchanged in the patients in Group B. The respiratory muscle endurance also increased significantly, from 47.9 ± 4.0 to 72.0 ± 4.2%, p < 0.001, in patients of Group A, and from 26.0 ± 2.9 to 43.4 ± 3.8, p < 0.001, in patients in Group B. The improved respiratory muscle performance was associated with a significant increase in the FEV, values, and in the FVC values, in patients of both groups. Mean dyspnea index score also increased significantly from 2.6 ± 0.8 to 3.6 ± 0.4 (p < 0.005) in Group A, and from 0.7 ± 0.2 to 2.0 ± 0.2 (p < 0.001) in Group B.Conclusions:Specific inspiratory threshold loading training alone, or combined with specific expiratory training, markedly improved respiratory muscle strength and endurance in patients with MG. This improvement in respiratory muscle performance was associated with improved lung function and decreased dyspnea. Respiratory muscle training may prove useful as a complementary therapy with the aim of reducing dyspnea symptoms, delay the breathing crisis and the need for mechanical ventilation in patients with MG.
Cervical Artery Dissection is Associated with Widened Aortic Root Diameter
Authors: Skljarevski Vladimir , Turek Michele , Hakim Antoine M. 
Published: February 2016

ABSTRACT:Objective:Dissection of the internal carotid and vertebral arteries is a well recognized cause of stroke, especially in the middle-aged. The exact etiology of this condition is controversial. According to one theory there is an underlying vasculopathy originating from disturbed development of the neural crest. The neural crest gives rise to several tissues, including the tunica media of large cervical arteries and the outflow tract of the heart. We attempted to test the theory that developmental abnormality at the level of the neural crest may play a role in dissection of the large cervical arteries.Methods:We designed a retrospective case control study. By means of transthoracic echocardiography we measured the aortic root diameter in a group of patients with radiographically determined dissection of at least one large artery in the neck. The results were compared to a control group.Results:In comparison to age matched controls, male patients were found to have a significantly larger aortic root. Although a similar trend was apparent in females, the difference between the patient and control group of females was not statistically significant.Conclusions:Patients with cervical artery dissections may have other abnormalities in organs arising from the neural crest. A larger prospective clinical study and further research are needed to establish a firm link between dissection of the cervical arteries and abnormalities in other organs.
Topiramate: Pharmacokinetics and Pharmacodynamics
Authors: Schneiderman J.H. 
Published: February 2016

ABSTRACT:Topiramate is a structurally novel anti-epileptic drug with at least 3 postulated mechanisms of action including: 1) potentiation of GABA responses, 2) impairment of AMPA/kainate glutamate receptors and 3) suppression of high frequency action potential firing. It has a favourable pharmacokinetic profile with rapid absorption, good bio-availability, linear pharmacokinetics, relatively long half-life and limited pharmacokinetic drug interactions. However, topiramate can reduce the estrogen component of oral contraceptive medications. Women may require birth control preparations containing 50 (Xg of estrogen. Topiramate clearance is reduced in severe renal failure and increased by enzyme-inducing antiepileptic drugs. The dose of topiramate may have to be reduced in renal failure or when withdrawing enzyme inducers.
Calmodulin-Dependent Cyclic Nucleotide Phosphodiesterase in Human Cerebral Cortex and Glioblastoma Multiforme
Authors: Lal Sumeer , Raju Rajala V.S. , Macaulay Robert J.B. , Sharma Rajendra K. 
Published: February 2016

AbstractBackground: Calmodulin-dependent cyclic nucleotide phosphodiesterase (CaMPDE) has been extensively studied and characterized in normal mammalian tissues; however very little is known about this enzyme in human brain tumors. It has been established that high levels of this enzyme exist in non-central nervous system tumors, PDE inhibitors or cAMP analogues have been used to treat them. This study has examined the levels of CaMPDE in glioblastoma multiforme from six patients and has compared these to the levels of CaMPDE in four patients with normal cerebral tissue. In addition, an enzyme immune assay method (EIA) was developed in this study for the detection of CaMPDE in human cerebral tissue. This method is proposed to be used as an adjunct to the spectrophotometric method presently utilized. This would be beneficial in cases where small tissue samples, for example in stereotactic biopsy, are available.Methods: The CaMPDE activity and corresponding levels of expression in cerebral tissue from temporal lobectomies and both surgical extraction or stereotactic biopsy in patients with primary tumors were determined by spectophotometric and EIA, respectively. The EIA was developed from the production of a polyclonal antibody against bovine brain 60 kDa CaMPDE isozyme. Cross reactivity of the antibody with human was confirmed using transblot and immunohistochemistry.Results: Utilising the EIA, there was found to be significant reduction in both catalytic activity (p < 0.001) and in quantitative protein expression (p < 0.001) in glioblastoma multiforme from patients when compared to normal cerebral cortex. Immunoblotting experiments and immunohistochemistry demonstrated that CaMPDE in glioblastoma multiforme failed to react with a polyclonal antibody raised against bovine brain 60 kDa CaMPDE isozyme, whereas the enzyme from normal tissue reacted with antibody.Conclusions: Contrary to other studies on non-CNS tumors, the catalytic activity and the protein expression of CaMPDE is reduced in glioblastoma multiforme. The EIA method is a more sensitive in detecting CaMPDE than in the spectrophotometric method, especially when a small amount of tissue is available. Immunohistochemistry and the EIA may be useful in the future to use as markers for other types of brain tumors and not for glioblastoma multiforme as demonstrated.
Impaired Incentive Learning in Treated Parkinson’s Disease
Authors: Charbonneau D. , Riopelle R.J. , Beninger R.J. 
Published: February 2016

AbstractObjective: To quantify the performance of patients with Parkinson’s disease (PD) in incentive learning, or learning to respond to stimuli that signal the imminent presentation of a reinforcer, and in paired-associate learning, or learning of word associations. Methods: The performance of 32 patients with idiopathic PD was compared to that of 25 healthy control subjects, and 32 subjects suffering from arthritis, matched for age and education. The PD and arthritic groups were comparable on a self-report measure of physical disability. All subjects were physically capable of satisfying the contingencies of the incentive learning task. The avoidance task that quantified incentive learning used money loss as an aversive stimulus. The word paired-associate learning task was presented on a computer and feedback was not given on performance. Results: The normal and arthritic groups performed equally well on the avoidance task, whereas the PD group was impaired despite dopaminergic replacement therapy. The groups did not differ significantly in paired-associate learning. Conclusions: These findings are among the first to suggest that the nigrostriatal dopamine dysfunction associated with PD may play a role in incentive learning but not in paired-associate learning and are consistent with a role for dopamine in certain forms of learning and memory. The findings may highlight differences between tonic and modulated function in the nigrostriatal system.
Relationship Between Sleep, Neck Muscle Activity, and Pain in Cervical Dystonia
Authors: Lobbezoo Frank , Thu Thon Marc , Rémillard Guy , Montplaisir Jacques Y. , Lavigne Gilles J. 
Published: February 2016

AbstractObjective: The interactions between sleep, neck muscle activity, and cervical spinal pain were examined in a controlled study with nine patients suffering from idiopathic cervical dystonia (ICD; also referred to as spasmodic torticollis), and nine gender- and age-matched controls. Methods: From each participant, two all-night polysomnograms with additional electromyographic recordings from the sternocleidomastoid and upper trapezius muscles were obtained. The first night was for habituation to the laboratory environment; the second night for experimental data collection. Visual analogue scales were used to collect intensity and unpleasantness ratings of cervical spinal pain before and after the second sleep recording. Results: None of the standard sleep variables showed statistically significant differences between average values of both groups of participants. However, a significantly larger variance in sleep latency was obtained for the ICD patients. In general, abnormal cervical muscle activity decreased immediately when lying down without the intention to go to sleep. Subsequently, abnormal muscle contractions were gradually abolished in all ICD patients during the transition from relaxed wakefulness to light NREM sleep. Following this transition phase, no more abnormal EMG activity was found in any of our patients. Finally, cervical spinal pain intensity and unpleasantness were reduced by about 50% overnight. Conclusions: Both supine position and sleep can be associated with an improvement of symptoms of ICD, and this disorder does not induce any sleep perturbations.
Triphasic Waves During Post-Ictal Stupor
Authors: Ogunyemi Abayomi 
Published: February 2016

AbstractBackground: The term, “triphasic wave” originally described an EEG pattern believed to be a marker for a specific stage of hepatic coma. For 4 decades, the diagnostic and prognostic specificity of the pattern remains controversial. Its pathophysiology also continues to be elusive. Methods: EEG recordings were obtained in three patients known or suspected to have primary generalized epilepsy. In 2 patients, the EEGs were part of long-term monitoring using simultaneous video-EEG telemetry. For the third patient, the EEG was secured only during the post-ictal unconsciousness. These 3 patients were specifically selected because of the presence of triphasic waves in their EEGs. Results: Triphasic waves were observed in the EEG of the 3 patients only during post-ictal unconsciousness. The pattern was transient, being preceded by generalized suppression and delta slow waves and followed by theta activities. Alpha rhythms supervened when the patients became fully alert. Conclusion: A post-ictal state should be considered in unconscious patients with triphasic EEG waves.
Stereotactic Management of Bacterial Brain Abscesses
Authors: Shahzadi Sohrab , Lozano Andres M. , Bernstein Mark , Guha Abhijit , Tasker Ronald R. 
Published: February 2016

ABSTRACT:Background:CT and MR guided stereotactic techniques have provided promising results in the management of brain abscesses. We reviewed our results of stereotactic management of brain abscesses in 20 consecutive patients with 28 abscesses from 1986 to 1993.Methods:13 abscesses were in the cerebral hemispheres, 12 in the cerebellum, 2 in the pons and 1 in the thalamus. The bacterial organism was isolated in 12 of the 20 cases. All patients, except one who had a tuberculous abscess, were on antibiotics for less than 7 weeks.Results:Although there were 3 patients in coma before surgery, the mortality rate was zero and 17 patients had an excellent recovery with 3 patients having a persistent mild neurologic disability. Stereotactic aspiration of the largest lesion in the patients with multiple brain abscesses combined with intravenous antibiotic therapy was sufficient for the resolution of all lesions. Two of our patients treated with antibiotics alone showed abscess progression with neurologic worsening.Conclusion:Stereotactic aspiration is safe, accurate, and when combined with the appropriate antibiotics, should be considered the procedure of choice in the management of brain abscesses.
Narcolepsy Secondary to Fourth Ventricular Subependymoma
Authors: Ma T.K.F. , Ang L.C. , Mamelak M. , Kish S.J. , Young B. , Lewis A.J. 
Published: February 2016

ABSTRACT:Background:Secondary (symptomatic) narcolepsy is rare. We report a subependymoma of the fourth ventricle associated with narcolepsy. The patient was a 50-year-old woman with a long history of narcolepsy who died of colonic carcinoma with no cerebral metastasis. She was positive for HLA-DR2. At autopsy there was a tumour dorsal to the fourth ventricle which involved the midbrain tectum and rostral pons. Histologic examination of the tumour confirmed it to be a subependymoma.Methods:Review of the previous cases of secondary narcolepsy was made with particular reference to the anatomical location of the lesions.Results:Most of the lesions were found around the third ventricle and rostral brainstem.Conclusions:Knowing the anatomical localization of the pathological changes in secondary narcolepsy could be important in improving our understanding of its pathogenesis.
Vertebral Artery Injury Associated with a Jefferson Fracture
Authors: Walsh Gregory S. , Cusimano Michael D. 
Published: February 2016

AbstractBackgroundThe evaluation and treatment of Jefferson fractures, a burst fracture of the ring of CI, has been well documented in the medical literature. Vertebral artery injury associated with a Jefferson fracture is very rare.MethodsThe case study technique was used to summarize the case. Review of the literature was performed to discuss the case. Retrospective chart review of the 174 patients with cervical fractures admitted to St. Michael’s Hospital from 1989–1994 was also performed.ResultsThe case of a patient with a Jefferson fracture, with bilateral lateral displacement of the lateral masses causing bilateral vertebral artery occlusions resulting in a lateral medullary and cerebellar infarction is reported. A review of the literature is provided.ConclusionA high index of suspicion for this injury is paramount, especially in patients with multiple trauma, where the diagnosis of Jefferson fractures can be delayed.
Long Term Intrathecal Baclofen Therapy in Patients with Intractable Spasticity
Authors: Becker W.J. , Harris C.J. , Long M.L. , Ablett D.P. , Klein G.M. , DeForge D.A. 
Published: February 2016

AbstractBackgroundSevere spasticity unresponsive to oral drugs may respond satisfactorily to baclofen delivered intrathecally.MethodsIntrathecal baclofen (IB) therapy delivered by means of implanted infusion pumps was used for nine patients with severe spasticity. Six patients had multiple sclerosis, two cervical spinal cord injury, and one head injury. All were non-ambulatory.ResultsPatients showed improvement in many areas, including ability to transfer, seating, pain control, personal care, and liability to skin breakdown. Before IB therapy, only three of the nine patients were able to live at home in the community and six were institutionalized. At the end of our follow-up period, only one patient remained institutionalized, three lived in group homes and five lived at home in the community. In the year preceding pump implantation, the nine patients spent a total of 755 days in acute care hospitals. In the year following onset of IB therapy, they spent only 259 days in hospital.ConclusionsIB therapy can improve patient quality of life and can be cost-effective in carefully selected patients with severe spasticity and disability. The drug delivery catheter is that part of the therapeutic system most vulnerable to failure. Because of the varied expertise required to manage these patients effectively, and the potential for a variety of complications, it is essential that an IB program is supported by a well-organized multi-disciplinary medical team.
Brain Herniation: A Revision of Classical Concepts
Authors: Fisher C. Miller 
Published: February 2016

AbstractThis paper is an update on evolving ideas about brain herniations. Following observations on cerebellar pressure coning that raised doubts about its reputed lethal connotations, herniation at the tentorium was re-examined for its role in critically damaging the brain stem. Combining clinical, pathologic, computed tomography and magnetic resonance imaging data, it is concluded that temporal lobe herniation is not the means by which the midbrain sustains irreversible damage in acute cases, but rather lateral displacement of the brain at the tentorium is the prime mover and herniation a harmless accompaniment. Transtentorial herniation has been investigated with computed tomography using the three calcification relationship and descent through the tentorial opening could not be documented. Bilateral brain stem compression in acute bilateral cases must be distinguished from herniation. Upward cerebellar herniation is only the sign of an overfull posterior fossa. Subfalcial herniation is tolerated unless lateral displacement is excessive.