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  • ISSN: 2334-2307
    Volume 8, Issue 1
    Original Article
    Gunnar Lindhe, Carin Bergfeldt and Ake Seiger*
    Aim: To highlight the self- perceived impact on everyday life of feeling cold in persons with acquired tetraplegia.
    Introduction: Spinal cord injury results in a multitude of functional deficits below the level of the injury. Most obvious is the more or less complete paralysis and loss of sensation. Less visible but of significant importance is the loss of temperature control when the injury is higher than thoracic level 6. This much neglected daily problem is subject to this study, where tetraplegic spinal cord injury individuals were informants.
    Design: Exploratory design with qualitative and semi- quantitative approach using a web-based questionnaire, reporting on self-perceived discomfort due to disturbed temperature regulation in persons with cervical spinal cord injury. Analyses were carried out by descriptive statistics and content analysis.
    Results: Results indicate that the functional disturbance almost invariably impacts on everyday life by feeling cold, coping strategies are mandatory, stake holders are either ignorant or at least inattentive to the problem, and that there is room for significant improvements in treatment programs for this target group.
    Conclusion: Persons with acquired tetraplegia report extensive impact on their everyday life by almost constantly feeling cold.
    Case Report
    Andréa C. Bautista, Michaela H. Bogan, and Catherine A. Mazzola*
    Background: Elevated intracranial pressure (ICP) may occur in children with secondary craniosynostosis associated with shunted hydrocephalus. Children with elevated ICP may present with headaches, visual complaints, nausea and/or vomiting, without focal neurological deficits. Papilledema may be seen through fundoscopy. Imaging may not show dilation of the cerebral ventricles. Skull x-rays and computed tomography (CT) may be suggestive of elevated intracranial pressure with craniosynostosis. This may occur in the setting of well or over-shunted hydrocephalus.
    Case Presentation: We present a child with a history of congenital hydrocephalus and ventriculoperitoneal (VP) shunt who was diagnosed with slit ventricle syndrome and severe craniosynostosis. Endoscopic third ventriculostomy (ETV) failed to ameliorate symptomatology, so the patient underwent an open cranial expansion, with multiple craniectomies, replacement of VP shunt, placement of an ICP monitor and cranial vault reconstruction. Post-operative studies demonstrated resolution of constricted intracranial spaces and brain compression.
    Conclusion: Indication of secondary craniosynostosis may be seen on neuroimaging scans and present with elevated ICP and severe headache. Children with this condition may benefit from ETV or cranial vault reconstruction and expansion.
    Research Article
    Salim Hirani*
    Background: The localization of ulnar nerve entrapment across wrist (UNEAW) may be categorised in a number of ways utilising one of a range of presently available methods via nerve conduction study (NCS). A number of approaches as to how to confirm entrapment at the wrist have been described in the literature. There are number of research paper showing several different ways to confirm entrapment.
    The aim of this research is to establish, using the best available evidence, a clinically appropriate revision of the current UNEAW nerve conduction study, and to compare this with existing Neurophysiological procedure.
    The proposed revised research is based on more nuanced, descriptive categories, ranging from ulnar sensory branch in digit V, mid palm ulnar sensory entrapment, sensor-motor entrapment across wrist and involvement of dorsal ulnar cutaneous nerve (DUCN).
    Method: A total of 46 hands were included in this study. Data was collected based on the extensive and detailed description mentioned in different research papers. The tests were performed by a qualified clinical physiologist (Neurophysiology) using a Keypoint 9033A07 machine, used in line with departmental protocol (Ulnar nerve screening protocol1.1, 2020). All data was recorded numerically to ensure methodological reliability.
    Result: Of the 46 hands tested, the NCS showed that 21 hands had entrapment only in ulnar sensory branch at digit V, 16 hands showed entrapment below wrist (at the palm), 12 hands showed entrapment across wrist (Guyon’s Canal), 11 hands showed entrapment across elbow involving ulnar sensory branch as well, and only one hand showed sensory entrapment above wrist due to a local injury.
    Conclusion: The ulnar nerve entrapment at or below wrist could easily be missed. Lack of familiarity of the anatomical localization of ulnar sensory nerve could be misdiagnosed with entrapment across elbow. Nerve conduction study is necessary to diagnose the level of entrapment of ulnar nerve at or below wrist.
    Rachel Mascari, Alexandra Vezzeti, Christine Orofino, Amanda Byrd, David Hicklin, Cynthia Nichols, James Curtis, and Souvik Sen*
    Objectives: We investigated whether periodontal disease is associated with specific stroke subtype.
    Materials and Methods: This is a single-center cross-sectional study. Periodontal disease was assessed in stroke and transient ischemic attack patients. Strokes caused by large-artery atherosclerosis were classified as intracranial atherosclerosis or extracranial atherosclerosis as well as anterior or posterior circulation disease.
    Results: Consecutive patients (N=265) were enrolled (age 64 ± 12.8, 49% white, 46% black, and 56% male). A third (N=87) had moderately severe periodontal disease. Twenty percent (N=42) were strokes due to large-artery atherosclerosis. Large-artery strokes had a higher proportion of patients with periodontal disease than without periodontal disease (31% vs.16%, X2 p=0.01). There was also a higher proportion of patients with periodontal disease (12% vs. 5%) with stroke due to posterior circulation disease (crude odds ratio or OR 3.0, 95% CI 1.1-7.9, p=0.03), which persisted after adjustment for covariates (adjusted OR 3.1, 95% CI 1.04-9.1, p=0.004). Periodontal disease patients had a higher rate of large-artery stroke due to intracranial atherosclerosis compared to those without periodontal disease (20% vs. 8%; crude OR 2.6, 95% CI 1.3-5.6, p=0.01), and this association persisted after adjustment (adjusted OR 2.6, 95% CI 1.1-5.8, p=0.004).
    Conclusions: We report a higher proportion of stroke due to large-artery atherosclerosis in patients with periodontal disease compared to those without periodontal disease. We report an independent association between periodontal disease and intracranial atherosclerosis, as well as between periodontal disease and posterior circulation disease.
    Eyad Abed Elaal*
    Stroke is one of the leading causes of mortality and morbidity worldwide. Stroke or cerebro-vascular disease (CVD) is a clinical syndrome with rapid onset and focal neurological deficits that last for at least twenty-four hours or otherwise death may the final end result.
    Huang Ying*
    Background: Chronic pain is more prevalent in the elderly, but its underling mechanism is unclear. Excessive activation of microglia and the following exaggerated inflammation in the spinal cord used to prove as a key point of initiating and maintaining neuropathic pain. And galectin-3, which is mainly expressed in microglia in the spinal cord, was further indicated to drive microglia activation and aggravate neuroinflammatory responses in the aged.
    Method: Von Frey test was chosen to test the mechanical threshold of sciatic chronic constriction injury (CCI) mice in both adult (10-12 weeks old) and aged (18-20 months old) group, with conditional position preference experiment further used to evaluate the spontaneous pain-like behavior in each group. Activation of spinal dorsal horn (DH) microglia and astrocytes were observed by immunofluorescence staining, and qPCR was performed to assess aging associated microglia mRNA expression in DH of both adult and aged mice with CCI. Glectin-3 expression in DH was also detected by Western Blot and immunofluorescence staining, and TD139, an inhibitor of Glectin-3, was further used to investigate the mechanism of increased allodynia in aged CCI mice.
    Results: The basic mechanical pain threshold of aged C57 mice is a little higher than adult mice, while they developed a more severe and persistent mechanical hyperalgesia and spontaneous allodynia than the adult. Spinal microglia also showed a much graver and durable activation in the aged after CCI surgery. Both mRNA and protein expression of galectin-3 in aged mice were significantly higher than those in adult, and CCI surgery exacerbated the disparity between different ages. TD139 administration remarkably alleviated the CCI induced allodynia and microglia activation in aged mice by inhibiting Galectin-3.
    Conclusion: Peripheral nerve injury induced neuropathic pain is much severer and more persistent in the aged, and this may due to its overfull expression of Galectin-3 in microglia, which also increases with age, and this excessive expressed Galectin-3 lead to drastic DH microglia activation and durable allodynia.
    Case Report
    KM Ward*, A Charmley, SJ Haughton, RP White
    Effective management of hyperacute stroke requires rapid decision making, utilizing clinical evaluation supported by imaging. Stroke mimic misdiagnosis may be associated with exposure to inappropriate reperfusion therapies. Recent imaging developments such as cerebral perfusion imaging improve patient selection, but are incompletely understood by clinicians.
    Hemiplegic-migraine is a classic stroke mimic characterized by unilateral motor weakness as an aura manifestation, consequent of uncoupling of cerebral blood flow and metabolism. Complex changes are observed on perfusion sequences which could lead to erroneous interpretation.
    We report a case of a 25-year-old male presenting with hyperacute left anterior circulation stroke symptoms with computed tomography (CT) perfusion imaging interpreted as such, with a favorable penumbra to core ratio in the left middle cerebral artery (MCA) territory. The imaging illustrated the poorly appreciated phenomenon of crossed cerebellar diaschisis (CCD). The patient was thrombolysed with complete resolution of symptoms and underwent patent foramen ovale (PFO) closure following extensive negative etiological investigations for his presumed stroke.
    Although the patient’s original presentation was thought to be consistent with acute ischemic stroke, a stereotypical re-presentation to hospital informed the final diagnosis of familial hemiplegic migraine.
    The clinico-radiologic differential diagnosis of stroke includes hemiplegic migraine in the absence of a proximal vessel occlusion. Imaging findings of hemispheric perfusion defect with CCD may have diagnostic value and is a widely under-recognised phenomenon. As CCD can be seen in both acute ischemic stroke and migraine with aura, hemiplegic migraine remains a convincing stroke mimic.
    Samantha Vanessa Cabrera-Chaves, Marley Judith Tapia-Julio, Brenda Carolina Amell-Barón, Jose Amado Villafaña-Herrera, Sabrina Rahman, Moshiur Rahman*
    Post-COVID-19 syndrome is an entity about which little is currently known. It has been defined as the persistence or appearance of symptoms following the acute phase of COVID-19, which may last up to 6 months, and these are related to target organ injury during the acute phase, in patients who may or may not have a history of previous disease [1-3]. Due to the above, there may be numerous phenotypes, which depend on the organ and severity of involvement [1-2]. However, the main phenotype described is the post-COVID 19 neurological syndrome, which can occur in patients with or without neurological manifestations, and can compromise the patient’s survival and functional prognosis [1-2].
    Review Article
    Dash SK*
    Alzheimer’s disease (AD) is the most common form of dementia. Amyloid plaques and neurofibrillary tangles are the characteristic pathology in AD, the amyloid plaques and neurofibrillary tangles causes the synaptic and neuronal loss, causing dementia. There is still neither efficient therapy for AD treatment nor preventive therapy available. Aβ (Amyloid beta) and tau are the main targets for therapy. Since long therapies targeting Aβ was the main focus of trial, but in recent year’s therapy targeting tau is getting importance, due to failure of agents targeting Aβ. In this article the various strategies targeting tau and their therapeutic value is discussed.
    Eyad Abed Elaal*
    Stroke, a global health problem is the leading cause of disability and mortality worldwide and a major cause of morbidity, mortality and disability, causing permanent damage, permanent disability, require long term rehabilitation.
    Research Article
    A Parmeggiani, DM Cordelli, E Franzoni, F Rossi*, M. Santini, B Valeriani, G Pizzo, G Trio, A Dalena, G Farneti, J Benassi, G Giannini, K Marzaduri3, and F Morchio
    The COVID-19 pandemic severely hit Italy in early 2020, forcing the government to arrange a general lockdown across the country. The condition of forced quarantine, already experienced in China, has led to a worsening of symptoms in subjects already suffering from psychopathology, including Eating Disorders. To avoid this, after the closure of the Service, the Day Hospital of the Regional Center on Eating Disorders of the UO of Child Neuropsychiatry of the Azienda Policlinico S. Orsola -Malpighi of Bologna has activated an online treatment program aimed at five adolescent patients and their parents. The meetings were conducted by the Psychotherapist, the Child Neuropsychiatrist, the Dietitian and the Family Psychotherapist. During the lockdown, tests were administered to the patients, compared with test administered in the entry, to see if the symptoms related to the eating disorder and general psychopathology had changed. In addition, other tests were administered to both patients and parents with the aim of investigating the dynamics established during quarantine, which measured psychological well-being and general functioning. The observation made it possible to identify five psychological phases that the patients faced, related to eating symptoms, family dynamics and adaptation to the pandemic. The tests did not show significant changes in the psychopathology of the patients, while comparing the results of the tests also administered to the parents, an influence between mother and daughter can be seen, with often overlapping trends in relation to symptom s. The online treatment was effective and satisfactory for both patients and parents, and within the family’s greater moments of communication, listening and mutual involvement in the life of family members developed while maintaining personal spaces.
    Research Article
    Lal Rehman, Munwar Ali, Ali Afzal, Farrukh Javeed*, Maham Khan
    Objective: To determine the frequency of residual aneurysm and major vessel occlusion following microsurgical clipping of anterior circulation aneurysms.
    Methodology: This prospective study was conducted at the department of Neurosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from August 2014 to December 2019. A total of 110 patients with anterior circulation aneurysms were included. All patients underwent four vessel digital subtraction angiography (DSA) before surgery and were operated with clipping across the neck of aneurysm. Postoperative DSA was done within one week after surgery and interpreted for radiological outcome. Outcome was assessed at one year on the basis of Modified Rankin Scale (mRS).
    Results: Among 110 patients, 66(60%) females and 44(40%) males were included, with a median age of 52.5 ± 10 years. Anterior Communicating Artery (ACOM) aneurysms were found in 58(52.7%) patients. Residual aneurysm was observed in 15(13.6%) and major vessel occlusion in 12(11%) cases. Based on Sindou classification, among 15 residual aneurysms, seven fell into grade I and three in grade II. At one year follow-up, in 87(79.1%) patients, there was no disability (mRS ≤2) while 23(20.9%) patients showed unfavorable outcome (mRS> 2). The overall mortality rate was 10% (n=11).
    Conclusion: Routine postoperative angiogram can reveal unexpected angiographic outcomes like major arterial occlusions, residual aneurysm and unclipped aneurysms. New focal deficit after surgery should alert the clinician to unexpected major arterial occlusion which can probably best be dealt with by immediate clip repositioning.
    Mini Review
    Meriem Tazir* and Sonia Nouioua
    Giant axonal neuropathy (GAN) is a rare neurodegenerative disorder in children characterized by damage to the peripheral nervous system with motor and sensory axonal neuropathy and the central nervous system, manifested primarily by cerebellar syndrome and pyramidal involvement with an aspect of leukodystrophy on brain MRI. The nerve biopsy shows a peculiar appearance of giant axons filled with disorganized neurofilaments. This condition is caused by mutations in the GAN gene encoding gigaxonin, a ubiquitous protein involved in the functions and dynamics of the cytoskeleton. In this review, we describe the clinical and neuropathological signs of this rare disease, with phenotypes-genotypes correlations, based on a personal series of 12 patients.
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