bluuebunny/crossref_metadata_2025_split huggingface dataset:
RAVLT and Nonverbal Analog: French Forms and Clinical Findings
Authors: Sziklas Viviane , Jones-Gotman Marilyn 
Published: December 2014

Background:Objective clinical evaluation of memory frequently requires serial testing but the issue of whether multiformed tests are equivalent and can be used interchangeably is seldom examined. An added problem in bilingual Canadian settings is the extent to which it is appropriate to measure French speakers’ performance on translations of English tests. The present work used the Rey Auditory Verbal Learning Test (RAVLT) and a nonverbal analog, the Aggie Figures Learning Test (AFLT), to examine whether a) different forms of the same test are equivalent, b) performance on the two tests is comparable, c) two language groups perform similarly, and d) the RAVLT can detect dysfunction in patients with temporal lobe epilepsy (TLE).Methods:We compared three French versions of the RAVLT and three forms of the AFLT in 114 healthy francophone adults. We subsequently compared the performance of the same francophone subjects to a previously obtained sample of anglophones on both tests, and then administered the RAVLT to anglophone or francophone patients with TLE.Results:For both tasks the three forms were equivalent and performance on the RAVLT was comparable to that on the AFLT. Francophone subjects performed slightly worse on the RAVLT compared to anglophones but performance of the two language groups did not differ on the AFLT. Finally, left TLE patients were impaired compared to right on the RAVLT, but no performance differences were observed across the two language groups in the patient sample.Conclusions:The RAVLT and AFLT are useful tools for examination of learning and memory in French and English speaking populations. On the RAVLT, the lesion effect in patients is not affected by differences in performance between language groups.
Diagnostic Accuracy of Neurological Problems in the Emergency Department
Authors: Moeller Jeremy J , Kurniawan Joelius , Gubitz Gordon J , Ross John A , Bhan Virender 
Published: December 2014

Background:Previous studies describe significant rates of misdiagnosis of stroke, seizure and other neurological problems, but there are few studies examining diagnostic accuracy of all emergency referrals to a neurology service. This information could be useful in focusing the neurological education of physicians who assess and refer patients with neurological complaints in emergency departments.Methods:All neurological consultations in the emergency department at a tertiary-care teaching hospital were recorded for six months. The initial diagnosis of the requesting physician was recorded for each patient. This was compared to the initial diagnosis of the consulting neurologist and to the final diagnosis, as determined by retrospective chart review.Results:Over a six-month period, 493 neurological consultations were requested. The initial diagnosis of the requesting physician agreed with the final diagnosis in 60.4% (298/493) of cases, and disagreed or was uncertain in 35.7% of cases (19.1% and 16.6% respectively). In 3.9% of cases, the initial diagnosis of both the referring physician and the neurologist disagreed with the final diagnosis. Common misdiagnoses included neurocardiogenic syncope, peripheral vertigo, primary headache and psychogenic syndromes. Often, these were initially diagnosed as stroke or seizure.Conclusions:Our data indicate that misdiagnosis or diagnostic uncertainty occurred in over one-third of all neurological consultations in the emergency department setting. Benign neurological conditions, such as migraine, syncope and peripheral vertigo are frequently mislabeled as seizure or stroke. Educational strategies that emphasize emergent evaluation of these common conditions could improve diagnostic accuracy, and may result in better patient care.
A Case of Foreign Accent Syndrome Resulting in Regional Dialect
Authors: Naidoo Raveeni , Warriner Erin M. , Oczkowski Wieslaw J. , Sévigny Alexandre , Humphreys Karin R. 
Published: December 2014

Background:Foreign Accent Syndrome (FAS) is a rare acquired syndrome following neurological damage that results in articulatory distortions that are commonly perceived as a “foreign” accent. The nature of the underlying deficit of FAS remains controversial. We present the first reported Canadian case study of FAS following a stroke. We describe a stroke patient, RD, who suffered an acute infarction to the left internal capsule, basal ganglia and frontal corona radiata. She was diagnosed as having FAS without any persistent aphasic symptoms. Family, friends, and health care professionals similarly described her speech as sounding like she had a Canadian East Coast accent, a reported change from her native Southern Ontario accent.Method:An investigation of this case was pursued, incorporating neuroimaging, neuropsychological and speech pathology assessments, and formalized linguistic analyses.Results:Linguistic analyses confirmed that RD’s speech does in fact have salient aspects of Atlantic Canadian English in terms of both prosodic and segmental characteristics. However, her speech is not entirely consistent with an Atlantic Canadian English accent.Interpretation:The fact that RD’s speech is perceived as a regional variant of her native language, rather than the “generic foreign accent” of FAS described elsewhere, suggests that the perceived “foreignness” in FAS is not primarily due to dysfluencies which indicate a non-native speaker, but rather due to very subtle motor-planning deficits which give rise to systemic changes in specific phonological segments. This has implications for the role of the basal ganglia in speech production.
Acute Electrical Stimulation of Nucleus Ambiguus Enhances Immune Function in Rats
Authors: Mei Ying-Wu , Yang Zhan-Qing , Wang Wei , Song De-Guang , Deng Xu-Ming , Liu Ju-Xiong 
Published: December 2014

Background:Up to now, many “immunoactive” brain areas have been identified, such a hypothalamic nuclei, brain reward system; but the nucleus ambiguous (Amb), a nucleus nervi vagis of medulla oblongata, was less well studied in neuroimmunomodulation.Methods:In order to obtain more profound comprehension and more knowledge on Amb, we studied the effect of acute electrical stimulation of Amb on thymus and spleen activity in rat. A stimulator was applied to stimulate the Amb of the anaesthetic rats using the parameter at 100μAx5ms x100 Hz every 1s for 1 min. The levels of TGF-β and thymosin-β4 mRNA in thymus, the release of IL-2 and IL-6 at splenocyte in vitro and splenic lymphocyte proliferation were measured at hour 0.5,1,2,3 following the electrical stimulation.Results:The results showed that concanavalin A (Con A)-induced splenic lymphocyte proliferation and the release of IL-2 and IL-6 were all significantly enhanced at 0.5, 1, and 2 h following effective Amb stimulation as compared to in the control group. However, as compared to in the control group, the levels of TGF-β and thymosin-β4 mRNA in the thymus were both remarkably reduced at 0.5, 1, and 2 h following effective Amb stimulation.Conclusions:These findings reveal that the Amb participates in the modulation of animal immune functions.
Tasks of Attention Augment Rigidity in Mild Parkinson Disease
Authors: Mendon¸a Dan A. , Jog Mandar S. 
Published: December 2014

Objective:The purpose of this study was to determine whether tasks involving effortful attention would cause augmentation of rigidity in patients with mild Parkinson disease.Methods:In 17 subjects with mild Parkinson disease, rigidity in a single arm was assessed during various experimental conditions by a blinded movement disorders neurologist. Rigidity was scored separately at the wrist and the elbow using an ordinal scale. In three of the conditions, sustained attention was directed toward visual, auditory or movement-related stimuli. Two varieties of Froment maneuver served as positive controls: contralateral hand opening-closing or ipsilateral foot tapping. In addition, rigidity was assessed twice with subjects resting. The examiner was unaware of the sequence of experimental conditions and this was changed for each subject. Mean rigidity scores for the various experimental conditions were compared against the baseline state (an average of both trials with the patient resting) using a repeated measures ANOVA and post-hoc Tukey-Kramer multiple comparisons test.Results:Rigidity was significantly increased from baseline with each of the attentional tasks (p <0.01 to p <0.001) and also with the two Froment maneuvers (p <0.001). Rigidity augmentation with contralateral hand opening-closing was significantly greater than with any of the attentional tasks (p <0.05 to p <0.001).Conclusion:Tasks of effortful attention did appear to augment rigidity in patients with mild Parkinson disease. We speculate that the greater augmentation seen with the Froment maneuver could have an anatomic basis.
Recombinant Factor VIIa plus Surgery for Intracerebral Hemorrhage
Authors: Sutherland Christina S. , Hill Michael D. , Kaufmann Anthony M. , Silvaggio Joseph A. , Demchuk Andrew M. , Sutherland Garnette R. 
Published: December 2014

Background:Hyperacute surgical evacuation of intracerebral hemorrhage is associated with a high rebleeding rate. The peri-operative administration of rFVIIa to patients with intracerebral hemorrhage may decrease the frequency of post-operative hemorrhage, and improve outcome.Methods:Patients receiving recombinant activated factor VII (rFVIIA) therapy immediately prior to acute surgery were collected at two centres. The intracerebral hemorrhage (ICH) score and ICH Grading Scale were determined, as was long-term outcome using the modified Rankin Scale. Residual/ recurrent clot was evaluated by comparing pre-operative to post-operative CT scans.Results:Fifteen patients with intracerebral hemorrhage received 40-90 μg/kg of rFVIIa and underwent surgical hematoma evacuation at a median time of five hours following symptom onset. Median pre-operative clot volume was 60 ml, decreasing to 2 ml post-operatively. There were no thromboembolic adverse events. Thirteen patients survived, 11 (73%) were independent, and two (13%) had a moderate to severe disability. These outcomes were significantly better than expected based on the median ICH score (40% mortality) and based on median ICH Grading Scale (18% good outcome).Conclusions:The pre or peri-operative administration of rFVIIa resulted in minimal residual or recurrent hematoma volume and may be an important adjunct to surgery in patients with intracerebral hemorrhage.
Inflammatory Cerebrospinal Fluid in Sporadic Creutzfeldt-Jakob Disease
Authors: Bui Esther , Ehrensperger Eric , Sahlas Demetrios J. , Murray Brian J. , Bergeron Catherine , Glikstein Rafael S. , Aviv Richard , Schipper Hyman M. 
Published: December 2014

Background:Sporadic Creutzfeldt-Jakob disease (CJD) is a fatal, transmissible spongiform encephalopathy characterized by rapidly progressive dementia, myoclonus, ataxia and akinetic mutism. The underlying mechanism is believed to be a conformational change of a native prion protein which characteristically fails to provoke an immune response. Commensurate with the latter, cerebrospinal fluid (CSF) classically exhibits a non-inflammatory profile.Cases:We report two patients with pathologically-proven sporadic CJD presenting with a significant CSF pleocytosis.Conclusion:Although uncommon, the presence of an inflammatory CSF profile should not exclude the diagnosis of sporadic CJD.
Comparison of Post-Operative Lordosis with the PEEK Cage and the Cervical Plate
Authors: Wilkinson Jeffrey S. , Mann Sumeer A. , Stoneham Grant W. , Hentschel Stephen , Fourney Daryl R. 
Published: December 2014

Abstract:Objective:The maintenance of post-operative lordosis has been shown to be a key factor in decreasing adjacent level disc stress. Previous studies of the PEEK (polyetherether ketone) cage have used intervertebral bony fusion as the primary measure of surgical success; however, little is known about its effects on spinal curvature. Our objective was to compare the PEEK cage to the cervical plate with respect to the maintenance of cervical lordosis at one year. Secondary outcomes included fusion and complication rates.Methods:We performed a retrospective study of patients who underwent ACDF (anterior cervical discectomy and fusion) by two different methods; 13 patients were treated with the PEEK cage, and 22 with allograft and plating.Results:Patient and treatment characteristics were similar in both groups. Average global lordotic curvature (C2-C7) was increased by 1.7 degrees for the PEEK cage and decreased by 1.6 degrees for the plate after an average follow-up of 12.46 and 14.95 months, respectively. Regional lordosis for the PEEK cage and plate was decreased by 2.5 and 2.1 degrees, respectively for the same time period. These differences did not achieve statistical significance. Bony fusion was observed in all patients. One patient in each group developed persistent mild dysphagia.Conclusions:The PEEK cage is comparable to the anterior cervical plate in the maintenance of post-operative cervical lordosis.
Stereotactic Radiotherapy: An Emerging Treatment for Spinal Metastases
Authors: Dahele Max , Fehlings Michael G. , Sahgal Arjun 
Published: December 2014

Aim:The purpose of this concise update is to describe the emerging treatment of stereotactic body radiotherapy (SBRT) for spinal metastases.Rationale:Spinal metastases are common and can present complex clinical challenges that conventional treatment cannot always meet satisfactorily. Examples include a history of prior irradiation at the same site or radio-resistant tumor histology. Stereotactic body radiotherapy makes it possible to deliver high doses of radiation with the aim of improving tumor control and palliation. It is increasingly being offered to selected patients including those requiring re-irradiation and post-operative treatment.Conclusion:It is important that specialists managing patients with spinal metastases are aware of the potential advantages of SBRT and how this can complement and extend existing treatment approaches, including spinal decompression and stabilization.
Patients' Perceptions of Carpal Tunnel and Ulnar Nerve Decompression Surgery
Authors: Khu Kathleen Joy , Bernstein Mark , Midha Rajiv 
Published: December 2014

Background:Carpal tunnel syndrome and ulnar nerve entrapment at the elbow are the most common entrapment neuropathies seen in adults. Surgery for nerve decompression is a safe and effective treatment option, and is usually performed under local anesthesia and as an outpatient procedure. This study aimed to explore patients' satisfaction and other aspects of the overall experience with this type of surgery.Methods:Qualitative research methodology was used. Semi-structured, open-ended interviews were conducted with 30 adult patients who had undergone carpal tunnel release or ulnar nerve decompression at the elbow 6-24 months prior. Interviews were digitally audio recorded and transcribed, and the data subjected to thematic analysis.Results:Four overarching themes emerged from the data: (1) most patients did not perceive their condition to be serious; (2) patients were satisfied with the overall surgical experience; (3) the outcome was more important to patients than the process; and (4) majority of patients had a realistic expectation of outcomes.Conclusions:Patients had a positive experience with carpal tunnel and ulnar nerve decompression surgery, although their level of satisfaction was dependent on the surgical outcome. Areas requiring improvement, specifically information about post-operative care and expectations of recovery, will be implemented in the future care of patients.
Quality of Life Following Hemicraniectomy for Malignant MCA Territory Infarction
Authors: Weil Alexander G. , Rahme Ralph , Moumdjian Robert , Bouthillier Alain , Bojanowski Michel W. 
Published: December 2014

Objective:Decompressive hemicraniectomy (DH) has been shown to reduce mortality in patients with malignant middle cerebral artery (MCA) territory infarction. However, many patients survive with moderate-to-severe disability and controversy exists as to whether this should be considered good outcome. To answer this question, we assessed the quality of life (QoL) of patients after DH for malignant MCA territory infarction in our milieu.Methods:The outcome of all patients undergoing DH for malignant MCAterritory infarction between 2001 and 2009 was assessed using retrospective chart analysis and telephone follow-up in survivors. Functional outcome was determined using Glasgow outcome scale, modifed Rankin scale (mRS), and Barthel index (BI). The stroke impact scale was used to assess QoL.Results:There were 14 patients, 6 men and 8 women, with a mean age of 44 years (range 27-57). All patients had reduced level of consciousness preoperatively. Five had dominant-hemisphere stroke. Median time to surgery was 45 hours (range 1- 96). Two patients died and one was lost to follow-up. Of 11 survivors, 7 (63.6%) had a favorable functional outcome (mRS<4). No patient was in persistent vegetative state. Despite impaired QoL, particularly in physical domains, the majority of interviewed patients and caregivers (7 of 8), including those with dominant-hemisphere stroke, were satisfied after a median follow-up of 18 months (range 6-43).Conclusion:Most patients report satisfactory QoL despite significant disability even in the face of moderate-to-severe disability and dominant-hemsiphere stroke. Dominant-hemisphere malignant MCA territory infarction should not be considered a contraindication to DH.
A Population-Based Study of Dystrophin Mutations in Canada
Authors: Mah Jean K. , Selby Kathryn , Campbell Craig , Nadeau Amelie , Tarnopolsky Mark , McCormick Anna , Dooley Joseph M. , Kolski Hanna , Skalsky Andrew J. , Smith R. Garth , Buckley David , Ray Peter N. , Yoon Grace 
Published: December 2014

AbstractIntroduction:We carried out a population-based study of dystrophin mutations in patients followed by members of the Canadian Paediatric Neuromuscular Group (CPNG) over a ten-year period.Objectives:We aimed to describe the changes in diagnostic testing for dystrophinopathy and to determine the frequency of dystrophin mutations from 2000 to 2009.Methods:De-identified data containing the clinical phenotypes, diagnostic methods, and mutational reports from dystrophinopathy patients followed by CPNG centres from January 2000 to December 2009 were analyzed using descriptive statistics.Results:773 patients had a confirmed diagnosis of dystrophinopathy based on genetic testing (97%), muscle biopsy (2%), or family history (1%). 573 (74%) had complete deletion/duplication analysis of all 79 exons or whole gene sequencing, resulting in 366 (64%) deletions, 64 (11%) duplications, and 143 (25%) point mutations. The percentage of patients who were diagnosed using currently accepted genetic testing methods varied across Canada, with a mean of 63% (SD 23). 246 (43%) mutations involved exons 45 to 53. The top ten deletions (n=147, 26%) were exons 45-47, 45-48, 45, 45-50, 45-55, 51, 45-49, 45-52, 49-50, and 46-47. 169 (29%) mutations involved exons 2 to 20. The most common duplications (n=29, 5.1%) were exons 2, 2-7, 2-17, 3-7, 8-11, 10, 10-11, and 12.Conclusion:This is the most comprehensive report of dystrophin mutations in Canada. Consensus guidelines regarding the diagnostic approach to dystrophinopathy will hopefully reduce the geographical variation in mutation detection rates in the coming decade.
Meta-Analysis of Randomized Trials on First Line and Adjunctive Levetiracetam
Authors: Lo Benjamin W. Y. , Kyu Hmwe H. , Jichici Draga , Upton Adrian M. , Akl Elie A. , Meade Maureen O. 
Published: December 2014

Context:New evidence suggests that levetiracetam may be as effective as traditional agents, with better safety profile.Objective:To synthesize evidence regarding efficacy and tolerability of levetiracetam as first line, adjunctive or prophylactic antiepileptic agent.Study Selection & Data Extraction:Eligible studies were randomized controlled trials (RCTs) of levetiracetam used in adults with epilepsy. MEDLINE, EMBASE, CENTRAL, CINHAL, PAPERSFIRST, PROCEEDINGSFIRST, PROQUEST and conference proceedings identified studies (to September 30, 2010). Two investigators independently selected, appraised studies, collected and analyzed data.Results:Of ten eligible randomized trials, eight investigated adjunctive levetiracetam for refractory seizures, one as monotherapy for newly diagnosed seizures, one as monotherapy for prophylaxis. Eight RCTs of adjunctive levetiracetam were of moderate quality (GRADE criteria), with two showing lack of allocation concealment. Meta-analyses showed adjunctive levetiracetam was more effective than placebo in achieving at least 50% reduction of seizure frequency, when added to baseline antiepileptic regimen (pooled RR 2.15 [1.65,2.82], I2 = 45%, p value (heterogeneity) = 0.08, p value (overall effect) < 0.01). Likelihood of serious adverse events necessitating withdrawal from study was not significantly different between levetiracetam and control (pooled RR 1.37 [0.88,2.13], I2 = 0%, p value (heterogeneity) = 0.84, p value (overall effect) = 0.17). Subgroup analyses suggested similar effects across different dosages. Sensitivity analysis of studies with adequate concealment showed similar effects.Conclusions:Levetiracetam is an effective adjunctive agent for refractory epilepsy. More studies are needed to establish whether it is effective as monotherapy for newly diagnosed seizures, and for prophylaxis in traumatic brain injury.
Misdiagnosis of Epileptic Seizures as Manifestations of Psychiatric Illnesses
Authors: Mirsattari Seyed M. , Gofton Teneille E. , Chong Derek J. 
Published: December 2014

Background:Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms or seizures occur in patients with known psychiatric illness.Methods:We present clinical profiles of six patients with epilepsy (three male, mean age 39 ± 12 years) that presented with prominent psychiatric symptoms.Results:Two patients had pre-existing psychiatric illnesses. Three patients were initially diagnosed with panic attacks, two with psychosis, and one with schizophrenia. Five patients had temporal lobe epilepsy (TLE) while the sixth patient was subsequently found to have absence status epilepticus (SE). Cranial computed tomogram (CT) including contrast study was unremarkable in five patients and showed post-traumatic changes in one patient. Cranial magnetic resonance imaging (MRI) revealed dysembryoplastic neuroepithelial tumour (DNET) in one patient, cavernous hemangioma in one, and post-traumatic changes plus bilateral mesial temporal sclerosis in another patient but it was normal in two TLE patients. Routine electroencephalography (EEG) revealed absence SE in one patient but it was non-diagnostic in the TLE patients. Video-EEG telemetry in the epilepsy monitoring unit (EMU) was necessary to establish the diagnosis in four TLE patients. None of the patients responded to medications aimed at treating psychiatric symptoms alone. Two patients required surgery while the other four required treatment with anti-epileptic drugs. All the patients had favorable response to the treatment of their epilepsy.Conclusions:This case series illustrates that epileptic patients may experience non-convulsive seizures that might be mistaken as primary psychiatric illnesses. In this subset of patients, evaluation by an epileptologist, MRI of the brain, and/or video-EEG telemetry in an EMU was necessary to confirm the diagnosis of epilepsy if routine EEGs and cranial CT are normal.