bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation Between MRI Findings and Histological Diagnosis of Brainstem Glioma
Authors: Yin Luxin , Zhang Liwei 
Published: December 2014

Objective:In most studies, treatment decisions of brainstem glioma are based solely on MRI features and do not incorporate a histopathological diagnosis. In the current study, we sought to compare MRI characteristics with histopathological findings of bainstem glioma.Methods:From April 2003 through April 2012, 150 patients were diagnosed with brainstem gliomas by MRI and microsurgically treated in Tiantan Hospital, Beijing, China. All the MRI and histopathological findings of these patients were respectively reviewed.Results:Of the 150 patients, 65 were female and 85 were male, 120 were adults and 30 were children (age < 18 years), 108 were low-grade glioma (72.0%), 35 were high-grade glioma (23.3%). The accuracy of the MRI diagnosis for brainstem glioma was 95.3%. Data analysis of the MRI findings revealed that a focal lesion was associated with a more favorable histopathological diagnosis in intrinsic (P=0.005) and exophytic (P=0.001) brainstem glioma patients. In the intrinsic diffuse type, tumors without enhancement had more favorable pathological findings (P=0.009).Conclusions:To our knowledge, this is the largest case series of this nature reported in the literature to date. The results of this study suggest that MRI features of brainstem gliomas could predict some pathological features and guide prognosis, choice of biopsy and treatment modalities. The pathology of tumors with a focal appearance on MRI was associated with a prognosis that was significantly better than their diffuse counterparts. For the intrinsic diffuse gliomas, non-enhancing tumors had pathology suggestive of a favorable prognosis.
Size Ratio: A Morphological Factor Predictive of the Rupture of Cerebral Aneurysm?
Authors: Li Meihua , Jiang Zhiqun , Yu Huiqiang , Hong Tao 
Published: December 2014

Background:Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult. We studied morphological factors associated with rupture in a study model of patients with mirror location intracranial aneurysms, one aneurysm that had ruptured and one that had not, each patient served as their own control attempting to eliminate confounding variables.Methods:We collected five one-dimensional measurements and four two-dimensional indices from three-dimensional rotational digital subtraction angiography images of patients in the proposed study model and explored their correlation with aneurysm rupture. Parameters were analyzed with a paired Student's t test for significance and significant parameters were further examined by multivariate conditional logistic regression analysis.Results:Fifty-two patients with 52 pairs of intracranial aneurysms in a mirror location were studied. The maximum perpendicular height, neck diameter, maximum width, maximum height, aspect ratio, size ratio, and bottleneck factor were significantly associated with ruptured aneurysms on bivariate analysis. A logistic regression analysis showed that only size ratio, which was defined as the ratio of the maximal height to parent artery average diameter, is independently correlated with ruptured intracranial aneurysms.Conclusions:In a case-control study of patients with mirror location intracranial aneurysms, size ratio was identified as the unique morphological factor associate with the rupture of cerebral aneurysms.
The Value of GRE, ADC and Routine MRI in Distinguishing Parkinsonian Disorders
Authors: Wadia Pettarusp M. , Howard Peter , Ribeirro Manuel Q. , Robblee Jennifer , Asante Abena , Mikulis David J. , Lang Anthony E. 
Published: December 2014

Objectives:To study different radiological signs and sequences including apparent diffusion coefficient (ADC) and gradient echo (GRE) to differentiate degenerative parkinsonian syndromes.Background:Multiple system atrophy (MSA), Parkinson's disease (PD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CbD) differ in the pattern of neurodegeneration and cellular damage. Measuring the ADC, GRE sequences for paramagnetic substances and simple anatomical assessments have been reported individually to assist in separating some of these disorders, but have not been compared.Methods:brain MRIs from May 2002 to February 2008 were retrospectively evaluated by raters blinded to the clinical diagnosis for predefined MRI signs on T1, T2 and GRE sequences. ADC values were quantitatively measured. Medical records were objectively analyzed using standard clinical criteria for different parkinsonian syndromes.Results:195 cases comprising of 61 PD, 15 MSA-P, 7 MSA-C, 21 PSP, 6 Corticobasal syndrome, 21 not fitting criteria and 64 controls were evaluated. 73% of patients with MSA-P had hypointensity of the putamen (compared to the pallidum) on GRE. The specificity of this sign to diagnose MSA-P was 90% versus PD and 76% versus PSP. When GRE hypointensity was combined with atrophy of the putamen the specificity improved to 98% (versus PD) and 95% (versus PSP) without altering the sensitivity. The ADC values were significantly higher in the middle cerebellar peduncle in cases with MSA-C versus controls, PD and PSP (p<0.001).Conclusions:The combination of hypointensity and atrophy of the putamen on GRE is useful in differentiating MSA-P from other parkinsonian syndromes.
The Expression of FOXJ1 in Neurogenesis after Transient Focal Cerebral Ischemia
Authors: Huang Yabo , Xu Zheng , Cao Jie , Cao Haibo , Zhang Shiming 
Published: December 2014

Objective and Background:FOXJ1 is a member of the Forkhead/winged-helix (Fox) family of transcription factors, which is required for the differentiation of the cells acting as adult neural stem cells which participate in neurogenesis and give rise to neurons, astrocytes, oligodendrocytes. The expression pattern of FOXJ1 in the brain after cerebral ischemia has so far not been described. In the current study, we investigated the expression pattern of FOXJ1 in the rat brain after cerebral ischemia by animal model.Methods:We performed a middle cerebral artery occlusion (MCAO) model in adult rats and investigated the expression of FOXJ1 in the brain by Western blotting and immunochemistry; double immunofluorescence staining was used to analyze FOXJ1's co-expression with Ki67.Results:Western blot analysis showed that the expression of FOXJ1 was lower than normal and sham-operated brain after cerebral ischemia, but the level of FOXJ1 gradually increased from Day 1 to Day 14. Immuohistochemical staining suggested that the immunostaining of FOXJ1 deposited strongly in the ipsilateral and contralateral hemisphere in the cortical penumbra (CP). There was no FOXJ1 expression in the ischemic core (IC). The positive cells in the cortical penumbra might migrat to the ischemic core. In addition, double immunofluorescence staining revealed that FOXJ1 was co-expressed with mAP-2 and gFAP, and Ki67 had the colocalization with NeuN, GFAP, and FOXJ1.Conclusions:All our findings suggest that FOXJ1 plays an important role on neuronal production and neurogenesis in the adult brain after cerebral ischemia.
Long-term Outcome of Infantile Gratification Phenomena
Authors: Jan Mohammed M. , Al Banji Mohammed H. , Fallatah Baraa A. 
Published: December 2014

Background:Infantile gratification phenomena are self-stimulatory behaviors that are often misdiagnosed as epilepsy. Although the prognosis is thought to be benign, limited long-term follow-up studies exist. This was the objective of our study in addition to exploring the risks of future developmental, behavioral, or neurological abnormalities.Methods:Series of consecutive infants with gratification phenomena were identified both retrospectively and prospectively over an eight year period from a single pediatric neurology service. The diagnosis was based on descriptive history, review of videotaped events, lack of neurological or developmental abnormalities, and normal routine electroencephalogram.Results:Nineteen infants were followed for 3-11 years (mean 7.1). Their ages ranged between 4-13 months (mean 7) with 79% females. The diagnosis was not reached by the referring physician and 74% were misdiagnosed as epilepsy or movement disorder. The episodes recurred with variable frequency with gradual reduction in number and increase in length of attack-free periods with advancing age. Complete remission was noted in all patients by age 1-3 years (mean 1.9). However, 4 children (21%) developed features of attention deficit hyperactivity disorders (ADHD) on long-term follow up. In this group, the gratification phenomena appeared at a younger age with higher attack frequency.Conclusions:Gratification phenomena in infants are benign and self-limited, often spontaneously disappearing by two years of age. A correlation with future ADHD was found; however, larger prospective studies are needed to further examine this possible association.
The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 1
Authors: Seshia Shashi S. , Young G. Bryan 
Published: December 2014

Abstract:The evidence-based medicine (EBM) paradigm, introduced in 1992, has had a major and positive impact on all aspects of health care. However, widespread use has also uncovered some limitations; these are discussed from the perspectives of two clinicians in this, the first of a two part narrative review. For example, there are credible reservations about the validity of hierarchical levels of evidence, a core element of the EBM paradigm. In addition, potential and actual methodological and statistical deficiencies have been identified, not only in many published randomized controlled trials but also in systematic reviews, both rated highly for evidence in EBM classifications. Ethical violations compromise reliability of some data. Clinicians need to be conscious of potential limitations in some of the cornerstones of the EBM paradigm, and to deficiencies in the literature.
Feasibility of a Dual Neurosurgeon-Scientist Career in Canada: A Survey Study
Authors: Girgis Fady 
Published: December 2014

Abstract:Objectives:Performing ‘good work’ in either neurosurgery or neuroscience alone is a challenge. Despite this, a large number of neurosurgeons divide their careers between the two fields, and attempt to excel in both arenas simultaneously. The purpose of this study is to explore perceptions on whether it is possible to do good work in both neurosurgery and research simultaneously, or whether one field suffers at the expense of the other.Methods:This question was put to practicing neurosurgeons via an electronic survey that was distributed to resident and staff neurosurgeons in Canada.Results:54 surgeons completed the survey, 32 of whom were current or intended neurosurgeon-scientists. Themes explored through the survey included motives behind the pursuit or absence of research in one's neurosurgical career, the quality and feasibility of a dual career, and alternatives to one individual assuming a dual role.Conclusions:The opinions obtained revealed that it is possible to do good work in both neurosurgery and neuroscience simultaneously, but in reality it is very difficult to do. Alternatives to this dual career, such as collaboration between clinical neurosurgeons and pure scientists for example, may help bridge the gap between clinical and research arenas.
Utility of the Canadian Treatment Optimization Recommendations (TOR) in MS Care
Authors: Grand'Maison François , Bhan Virender , Freedman Mark S. , Myles Mary L. , Patry David G. , Selchen Daniel H. , Moriarty Patrick , Traboulsee Anthony L. 
Published: December 2014

AbstractObjectives:Criteria for Treatment Optimization Recommendations (TOR) for patients with multiple sclerosis (MS) identify suboptimal response to disease-modifying treatment (DMT). The Canadian TOR (CanTOR) were used to indicate recommendations for treatment switches or treatment maintenance based on relapse, disease progression and magnetic resonance imaging (MRI) criteria in patients. We assessed concordance between the TOR and clinicians' decisions regarding treatment response and identified prevalence of patients with MS receiving DMT meeting medium/high levels of concern according to TOR.Methods:Prospective baseline and end-of-study assessments of patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome were conducted in this open-label, 12-month, Phase IV, observational Canadian study.Results:Data were reported for 184 patients (female 72%, mean age 39 years) of which 96% had RRMS. The TOR criteria identified 19 (10.3%) patients with suboptimal response to treatment. Twelve patients had ≥1 high level of concern. Two patients had ≥2 medium levels of concern. Concordance between TOR and clinician decision in maintaining treatment was 95.3%. Where treatment change was recommended by the TOR, concordance was 29.4%. Clinicians identified the TOR as the principal reason for changing treatment in 50.0% of cases where the TOR identified suboptimal response. The TOR were considered useful by 70.6% of clinicians when treatment optimization was recommended and by 55.3% when maintaining treatment was recommended.Conclusions:The TOR criteria can identify suboptimal response in this patient cohort. Concordance between TOR and clinician decision was high when maintaining treatment was recommended. Usefulness of the TOR was most apparent when treatment optimization was recommended.
Gamma Knife in the Treatment of Pituitary Adenomas: Results of a Single Center
Authors: Zeiler F. A. , Bigder M. , Kaufmann A. , McDonald P. J. , Fewer D. , Butler J. , Schroeder G. , West M. 
Published: December 2014

Abstract:Introduction:Gamma Knife (GK) radiosurgery for pituitary adenomas can offer a means of tumor and biologic control with acceptable risk and low complication rates.Methods:Retrospective review of all the patients treated at our center with GK for pituitary adenomas from Nov 2003 to June 2011.Results:We treated a total of 86 patients. Ten were lost to follow-up. Mean follow was 32.8 months. There were 21 (24.4%) growth hormone secreting adenomas (GH), 8 (9.3%) prolactinomas (PRL), 8 (9.3%) adrenocorticotropic hormone secreting (ACTH) adenomas, 2 (2.3%) follicle stimulating hormone/luteinizing hormone secreting (FSH/LH) adenomas, and 47 (54.7%) null cell pituitary adenomas that were treated. Average maximum tumor diameter and volume was 2.21cm and 5.41cm3, respectively. The average dose to the 50% isodose line was 14.2 Gy and 23.6 Gy for secreting and non-secreting adenomas respectively. Mean maximal optic nerve dose was 8.87 Gy. Local control rate was 75 of 76 (98.7%), for those with followup. Thirty-three (43.4%) patients experienced arrest of tumor growth, while 42 (55.2%) patients experienced tumor regression. Of the 39 patients with secreting pituitary tumors, 6 were lost to follow-up. Improved endocrine status occurred in 16 (50.0%), while 14 (43.8%) demonstrated stability of hormone status on continued pre-operative medical management. Permanent complications included: panhypopituitarism (4), hypothyroidism (4), hypocortisolemia (1), diabetes insipidus (1), apoplexy (1), visual field defect (2), and diplopia (1).Conclusions:Gamma Knife radiosurgery is a safe and effective means of achieving tumor growth control and endocrine remission/stability in pituitary adenomas.
The Burden of Inpatient Neurologic Disease in a Tropical African Hospital
Authors: Philip-Ephraim E. E. , Eyong K. I. , Chinenye S. , William U. E. , Ephraim R. P. 
Published: December 2014

Abstract:Background:Neurologic disorders represent a major burden of disease globally and the spectrum ranges from noncommunicable disorders like stroke and neurodegenerative disorders to central nervous system infections.Objective:The purpose of the study is to assess the burden of neurological diseases in a tropical environment.Methods:A one year retrospective survey of neurological diseases seen at the University of Calabar Teaching Hospital, Nigeria, was evaluated using patients' medical record.Results:Neurological diseases constituted 24.2% of all medical conditions seen over a one year period. Stroke was found to be the commonest cause of admissions accounting for 42.1% of the cases followed by peripheral neuropathy (13.8%) and meningoencephalitis (7.2%). The immediate case fatality rate was 33.6%. Fifty two percent were discharged home with various levels of recovery while 12.5% left against medical advice. About 2% were referred to other tertiary health institutions.Conclusion:The pattern of neurologic diseases in the local medical wards was not remarkably different from those observed in Nigeria and elsewhere. Stroke remains the most frequent cause of neurologic admissions and mortality in this region is same as observed elsewhere.
Neuroinvasive West Nile Virus Disease in Canada. The Saskatchewan Experience
Authors: Téllez-Zenteno José F. , Hunter Gary , Hernández-Ronquillo Lizbeth , Haghir Edrish 
Published: December 2014

Abstract:Background:West Nile virus (WNV) is a virus of the family Flaviviridae. The main route of human infection is through the bite of an infected mosquito. Approximately 90% of WNV infections in humans are asymptomatic, but neurologic manifestations can be severe.Methods:This study reviews the clinical profile of cases with neuroinvasive West Nile infection (NWNI) reported by the Surveillance program of the government of Saskatchewan in the Saskatoon Health Region (SHR). In 2007, 1456 cases of human West Nile cases were reported by the government of Saskatchewan in the whole province. One hundred and thirteen cases had severe symptoms of NWNI (8%), 1172 (80%) cases had mild symptoms of WNI and 171 (12%) had asymptomatic disease. Three hundred and fifty six cases were reported in the SHR, where 57 (16%) fulfilled criteria for NWNI.Results:From the 57 cases, 39 (68%) were females. Nine (16%) patients had a history of recent camping, two (4%) reported outdoor sports and four (8%) reported outdoor activities not otherwise specified. Twenty five patients had headache (43.9%), 25 confusion (42.1%), 23 meningitis (40.4%), 17 encephalitis (29.8%), 14 encephalopathy (24.6%), 11 meningoencephalitis (19.3%), 10 tremor (17.5%), acute flaccid paralysis 10 (17.5%), myoclonus 1 (1.8%), nystagmus 2 (3.5%), diplopia 2 (3.5%), dizziness 2 (3.5%). Three patients died related with comorbidities during admission.Conclusion:During a year of high occurrence of WNI in Saskatchewan, 16% of cases developed NWNI. The recognition of neurological complications associated with WNI is important to improve their referral to tertiary centers.
Epidemiological Surveillance of Amyotrophic Lateral Sclerosis in Saguenay Region
Authors: Lareau-Trudel Émilie , Fortin Élizabeth , Gauthier Marianne , Lavoie Sarah , Morissette Érika , Mathieu Jean 
Published: December 2014

Abstract:Objectives:The Neuromuscular Registry of Saguenay-Lac-Saint-Jean (SLSJ), Québec, Canada was established for epidemiological surveillance of neuromuscular disorders including amyotrophic lateral sclerosis (ALS). The objectives of this study are to analyze the ALS clinical characteristics of the SLSJ population and to determine the incidence rate over time by five year periods since 1985.Methods:The Registry was validated by a review of the medical records maintained at the CSSS de Chicoutimi, the regional university hospital and, by the estimation of the number of hospitalizations for ALS patients using the Quebec Hospital inpatient database (MED-ECHO).Results:A total of 109 patients were included. Overall, the clinical features of ALS observed in SLSJ population are similar to those described in the literature. We observed a significant increase in the incidence rate of ALS during the 2005-2009 period compared with the previous periods. This is due to a significant increase in the incidence rate among the ≥65 years old group, from 4.68 per 100,000 persons/year (CI 95% 2.88-6.48) during 1985-2004 period to 12.22 (CI 95% 7.43-17.02) during 2005-2009 period.Conclusion:Given the small size of the SLSJ population, a longer observation period will be needed to confirm a new steady state incidence of ALS in this region.
Evaluation of a Bicycle Helmet Safety Program for Children
Authors: Cusimano Michael D. , Faress Ahmed , Luong Wilson P. , Lockhart Sally , Amin Khizer , Garland Rhonda J. , Russell Kelly 
Published: December 2014

Abstract:Background:Helmets have been shown to decrease the risk of brain injury; however, helmets must be worn correctly and fit well in order to be effective. The objective of this study is to determine whether kindergarten-aged children could learn and retain appropriate helmet wearing technique through an educational bicycle safety program.Methods:Retrospective analysis of scores in questionnaires administered before and after an educational intervention to kindergarten students four to six years of age. The study took place in Prince Edward Island, Canada. A Wilcoxon Sign-Rank Test was used to determine if there was a significant overall increase in knowledge; McNemar chi-square tests were used to determine if there was an increase in knowledge for individual questions.Results:There was significant improvement in pre-test to immediate post-tests scores and pre-test to delay post-test scores when the results were stratified by age, sex, bike riding status, and helmet wearing status (p<0.001 for all comparisons). In particular, correct responses for the questions regarding appropriate helmet distances from the eyes increased from 38.9% in the pre-test to above 90% in the post-tests (p<0.001). Correct responses for the question pertaining to appropriate fitting of helmet straps increased from 71.7% pre-test to above 90% in the post-tests (p<0.001).Conclusions:There was improved knowledge of appropriate helmet-wearing technique among kindergarten-aged children as a result of the educational intervention, and knowledge gains were retained for at least one month.
Gamma Knife Radiosurgery of Cavernous Sinus Meningiomas: An Institutional Review
Authors: Zeiler F. A. , McDonald P. J. , Kaufmann A. M. , Fewer D. , Butler J. , Schroeder G. , West M. 
Published: December 2014

Introduction:Stereotactic radiosurgery offers a unique and effective means of controlling cavernous sinus meningiomas with a low rate of complications.Methods:We retrospectively reviewed all cavernous sinus meningiomas treated with Gamma Knife (GK) radiosurgery between November 2003 and April 2011 at our institution.Results:Thirty patients were treated, four were lost to follow- up. Presenting symptoms included: headache (9), trigeminal nerve dysesthesias/paresthesias (13), abducens nerve palsy (11), oculomotor nerve palsy (8), Horner's syndrome (2), blurred vision (9), and relative afferent pupillary defect (1). One patient was asymptomatic with documented tumor growth. Treatment planning consisted of MRI and CT in 17 of 30 patients (56.7%), the remainder were planned with MRI alone (44.3%). There were 8 males (26.7%) and 22 females (73.3%). Twelve patients had previous surgical debulking prior to radiosurgery. Average diameter and volume at time of radiosurgery was 3.4 cm and 7.9 cm3 respectively. Average dose at the 50% isodose line was 13.5 Gy. Follow-up was available in 26 patients. Average follow-up was 36.1 months. Mean age 55.1 years. Tumor size post GK decreased in 9 patients (34.6%), remained stable in 15 patients (57.7%), and continued to grow in 2 (7.7%). Minor transient complications occurred in 12 patients, all resolving. Serious permanent complications occurred in 5 patients: new onset trigeminal neuropathic pain (2), frame related occipital neuralgia (1), worsening of pre-GK seizures (1), and panhypopituitarism (1).Conclusion:GK offers an effective treatment method for halting meningioma progression in the cavernous sinus, with an acceptable permanent complication rate.