Vivien X. Xie, Gilbert Vezina, John S. Myseros
et al.
Abstract Objective Diffuse intrinsic pontine gliomas (DIPG) are high‐grade tumors with a dismal prognosis and are classically diagnosed by radiologic features. DIPG is a critical differential consideration for a pediatric patient presenting with an infiltrative brainstem mass. However, inflammatory and infectious etiologies must also be considered, especially in individuals with atypical radiographic features. In a carefully selected clinical scenario, biopsy can be employed to quickly diagnose and direct treatment for patients with brainstem masses. Results This 10‐year‐old girl presented with acute onset of dysarthria, ataxia, left‐sided weakness, hypertonicity, and dysmetria. Magnetic resonance imaging revealed an infiltrative pontine lesion with atypical features for that of DIPG or specific inflammatory disease. Due to rapid clinical deterioration, stereotactic brainstem biopsy was performed for diagnostic clarity and showed inflammation but no malignant cells. She was then treated for a presumed antibody‐mediated autoimmune etiology with evaluation later revealing neuromyelitis optica spectrum disorder (NMOSD) and autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy overlap syndrome. Interpretation We present a novel example of pediatric NMOSD and autoimmune GFAP astrocytopathy overlap syndrome originally presenting as an infiltrative pontine mass. Our report highlights the safety and utility of brainstem biopsy for brainstem masses atypical for DIPG.
Neurology. Diseases of the nervous system, Pediatrics
Sultan Saad Alsubaie Department of Psychiatry, Armed Forces Hospital, Khamis Mushayt, Saudi ArabiaCorrespondence: Sultan Saad Alsubaie, Consultant Psychiatrist, psychiatry department, Armed Forces Hospital Southern Region, P.O. Box 101, Khamis Mushayt, Saudi Arabia, Tel +96-6503799971, Email dr.slt4444@gmail.comPurpose: This study aims to compare self-esteem and social anxiety disorder (SAD) symptoms levels between visually impaired and sighted individuals, and to explore the relationship between social anxiety and various sociodemographic factors.Materials and Methods: A case-control study was conducted from March to June 2017 in Riyadh, Saudi Arabia, involving 62 participants (24 visually impaired and 38 sighted). Participants completed a demographic form, the Liebowitz Social Anxiety Scale (LSAS), and the Rosenberg Self-Esteem Scale (RSES). Data analysis included descriptive statistics, and t-tests to compare psychological outcomes between groups.Results: The mean age of visually impaired participants was significantly higher than that of sighted participants (24± 2.8 vs 22.4± 2.2 years, p=0.013). No significant differences were observed between the two groups in terms of gender, marital status, or education level. The RSES scores indicated no significant difference in self-esteem between visually impaired and sighted individuals (18.13± 2.66 vs 17.42± 2.04, p=0.244). Similarly, LSAS scores did not significantly differ between the two groups (32.63± 24.19 vs 36.68± 22.68, p=0.506).Conclusion: The findings suggest that visually impaired individuals do not have significantly different levels of self-esteem or social anxiety compared to their sighted peers, indicating that visual impairment may not directly contribute to lower self-esteem or higher social anxiety. Future research should involve larger, more diverse samples and longitudinal studies to further explore these relationships.Keywords: social anxiety disorder, self-esteem, visually impaired, sighted individuals, case-control study, Saudi Arabia
Neurosciences. Biological psychiatry. Neuropsychiatry, Neurology. Diseases of the nervous system
Rachel Richmond, Rosemary Ricciardelli, Joy MacDermid
et al.
Introduction: Public safety personnel (PSP) experience stressors which may affect their mental health, occupational responsibilities, performance on duty, and their families. In the current article, we explore the development and implementation of family-forward initiatives within public safety organizations. In reflecting on public safety implementation leaders' experiences of developing and implementing family-forward innovations, we aim to understand the crucial constructs involved in developing and implementing effective innovations. Methods: Fifteen public safety leaders with previous experience implementing a family-forward initiative, from four public safety sectors, participated in semi-structured interviews about their experiences with implementing family-forward initiatives to reveal the conditions under which these initiatives were conducted among different public safety contexts. We mapped the interview data onto the Consolidated Framework of Implementation Research (CFIR), and present the relevant constructs needed to be considered for future initiatives. Results: Participants identified four types of family-forward innovations implemented across four public safety sectors: i) community building, ii) social norming, iii) building awareness and skills, and iv) communication channels. Leadership, resources, and a climate of readiness were instrumental in the implementation of family-forward initiatives. Conclusion: Knowledge of these implementation constructs can be used to improve and adapt family-forward initiatives for the future as well as for development and implementation of initiatives for other public safety sectors.
BackgroundLower limb motor dysfunction is one of the most serious consequences of stroke; however, there is insufficient evidence for optimal rehabilitation strategies. Improving lower limb motor function through effective rehabilitation strategies is a top priority for stroke patients. Neuroplasticity is a key factor in the recovery of motor function. The extent to which neuroplasticity-based rehabilitation therapy using brain-computer interface (BCI) is effective in treating lower limb motor dysfunction in acute ischemic stroke patients has not been extensively investigated.ObjectiveThis study aimed to assess the impact of BCI rehabilitation on lower limb motor dysfunction in individuals with acute ischemic stroke by evaluating motor function, walking ability, and daily living activities.MethodsThis study was conducted in a randomized controlled trial, involving 64 patients with acute ischemic stroke who experienced lower limb motor dysfunction. All patients were divided into two groups, with 32 patients assigned to the control group was given conventional rehabilitation once a day for 70 min, 5 times a week for 2 weeks, and the experimental group (n = 32) was given BCI rehabilitation on top of the conventional rehabilitation for 1 h a day, 30 min of therapy in the morning and an additional 30 min in the afternoon, for a total of 20 sessions over a two-week period. The primary outcome was lower extremity motor function, which was assessed using the lower extremity portion of the Fugl-Meyer Rating Scale (FMA-LE), and the secondary endpoints were the Functional Ambulation Scale (FAC), and the Modified Barthel index (MBI).ResultsAfter 20 sessions of treatment, both groups improved in motor function, walking function, and activities of daily living, and the improvements in FMA-LE scores (p < 0.001), FAC (p = 0.031), and MBI (p < 0.001) were more pronounced in the experimental group compared with the control group.ConclusionConventional rehabilitation therapy combined with BCI rehabilitation therapy can improve the lower limb motor function of hemiplegic patients with stroke, enhance the patient’s ability to perform activities of daily living, and promote the improvement of walking function, this is an effective rehabilitation policy to promote recovery from lower extremity motor function disorders.
Abstract The glymphatic system (GS) is a newly discovered transport system in the central nervous system (CNS) that plays a crucial role in maintaining homeostasis by facilitating the clearance of metabolic waste and fluid transport. This groundbreaking discovery has significantly advanced our understanding of CNS physiology. Historically, the brain was thought to lack a lymphatic system, leaving its mechanisms for waste clearance largely enigmatic. This review elaborates on the anatomical structures of the GS, including the perivascular space, aquaporin 4 (AQP4) channels, and the meningeal lymphatic system, as well as their functional dynamics, to elucidate the GS's waste clearance mechanism. It also explores the key factors influencing GS activity, such as sleep, arterial pulsation, aging, and pharmacological interventions. Moreover, it examines the implications of GS dysfunction in various neurological diseases, including stroke, Alzheimer's disease, and Parkinson's disease. Furthermore, it discusses the latest diagnostic and therapeutic strategies targeting this vital system. Understanding the role of the GS in CNS homeostasis not only provides new insights into the pathophysiology of neurological diseases but also opens novel avenues for therapeutic interventions to enhance brain health and mitigate neurodegenerative processes.
The psychiatric assessment of elderly differs from assessment of adult patients on various accounts. In this continuing medical education series, we discuss the generic aspects of psychiatric assessment of elderly. In this document we describe the SAFEST approach for psychiatric evaluation of elderly. This involves understanding the signs and symptoms [S], Additional Diagnosis- comorbid physical and psychiatric diagnosis [A], level of functioning, frailty, falls, forceful acts-abuse, forensic issues [F], collecting extra information pertaining to nutritional status, the environment in which the patient is living, constipation, urinary symptoms (incontinence/retention), and weight loss [E], understanding the ongoing stressors, suicidality, substance use disorder, sleep-related issues, sexual history, supervision of medication, safety issues, social support, spirituality and religiousness [S] and collecting the treatment history [T]. Clinicians should also give due importance to physical examination. While carrying out the mental status examination due importance must be given to assessment of cognitive functions. Basic investigations must be carried out in all the elderly patients, whenever feasible before starting psychotropic medications. A detailed case formulation should be made by taking the history, physical examination findings, mental status examination findings and the investigations.
Nur Shairah Mohamad Faizal, Juen Kiem Tan, Michelle Maryanne Tan
et al.
Background Delirium is a prevalent yet underdiagnosed disorder characterized by acute cognitive impairment. Various screening tools are available, including the Confusion Assessment Method (CAM) and 4 A’s test (4AT). However, the results of these assessments may vary among raters. Therefore, we investigated the objective use of electroencephalography (EEG) in delirium and its clinical associations and predictive value. Method This cross-sectional observational study was conducted at Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan, Malaysia, from April 2021 to April 2023. This study included patients aged ≥18 years with a preliminary diagnosis of delirium. Demographic and clinical data were collected along with EEG recordings evaluated by certified neurologists to classify abnormalities and compare the associated factors between patients with delirium with or without EEG abnormalities. Results One hundred and twenty patients were recruited, with 80.0% displaying EEG abnormalities, mostly generalized slowing (moderate to severe) and primarily generalized slowing (mild to severe), and were characterized by theta activity. Age was significantly associated with EEG abnormalities, with patients aged 75 and older demonstrating the highest incidence (88.2%). The CAM scores were strongly correlated with EEG abnormalities (r = 0.639, P < 0.001) and was a predictor of EEG abnormalities ( P < 0.012), indicating that EEG can complement clinical assessments for delirium. The Richmond Agitation and Sedation Scale (RASS) scores (r = −0.452, P < 0.001) and Barthel index (BI) (r = −0.582, P < 0.001) were negatively correlated with EEG abnormalities. Additionally, a longer hospitalization duration was associated with EEG abnormalities (r = 0.250, P = 0.006) and emerged as a predictor of such changes ( P = 0.030). Conclusion EEG abnormalities are prevalent in patients with delirium, particularly in elderly patients. CAM scores and the duration of hospitalization are valuable predictors of EEG abnormalities. EEG can be an objective tool for enhancing delirium diagnosis and prognosis, thereby facilitating timely interventions.
Andreas Simgen, Sebastian Antes, Philipp Dietrich
et al.
The Woven Endobridge (WEB) device serves as an endosaccular flow-disruptor in the treatment of wide-necked cerebral aneurysms. Despite the varying availability of different WEB sizes, there are still limitations. Especially aneurysms with an width and height larger than 10 mm and 10.4 mm pose a particular challenge. Here we present a case report and technical note in the treatment of a large middle cerebral artery (MCA) aneurysm using the WEB device and adjunctive coiling. WEB-assisted coiling (WAC) of large aneurysms is a rarely described technique that allows intrasaccular embolization alone without the need for intracerebral stenting. Accurate sizing of the WEB device is very important in such cases. However, aneurysm recurrence must be considered and may require further treatment. More research is needed to further evaluate the safety and success of this technique.
Surgery, Neurology. Diseases of the nervous system
Introduction
Cri du Chat syndrome (CdCS) is a genetic disorder resulting from a variable size deletion of the end of the short arm of chromosome 5 (5p), including a critical region located at p15.2. It represents one of the most frequent chromosomal deletions, with an incidence in the general population of 1/20,000 to 1/50,000.
Objectives
Through this observation we update the scientific news of this rare syndrome and present an observation of a Cri du Chat syndrome confirmed by metaphasic karyotype (46,XY,del(5)(p13) de novo) with autism spectrum disorder.
Methods
Description a case with cat cry syndrome seen in child psychiatry consultation in our institution
Discussion through articles published on pubmed, googlescholar and science direct
Results
Typical features of CoCs present in the subject include intellectual disability, psychomotor acquisition delays, language delay, and dysmorphic features (e.g., wide and high nasal root, hypertelorism, and coarseness of features). Expected features of CoCs that are not present are: growth retardation, microcephaly, round facies, micrognathia, epicanthal folds and characteristic high-pitched cry. Behavioral features in this subject include symptoms of autism spectrum disorder.
Conclusions
The deletion of the short arm of chromosome 5, when it includes a critical region located at p15.2, is responsible for a well-characterized syndrome, Cri-du-Chat disease, including a characteristic craniofacial dysmorphia that evolves with age, the mental handicap in the characteristic form is very severe. Visceral malformations are relatively rare and not very specific.
Disclosure of Interest
None Declared
Background The impact of the COVID-19 pandemic on the population’s mental health is vital for informing public health policy and decision-making. However, information on mental health-related healthcare service utilisation trends beyond the first year of the pandemic is limited.Aims We examined mental health-related healthcare service utilisation patterns and psychotropic drug dispensations in British Columbia, Canada, during the COVID-19 pandemic compared with the prepandemic period.Methods We conducted a retrospective population-based secondary analysis using administrative health data to capture outpatient physician visits, emergency department visits, hospital admissions and psychotropic drug dispensations. We examined time trends of mental health-related healthcare service utilisation and psychotropic drug dispensations between January to December 2019 (prepandemic period) and January 2020 to December 2021 (pandemic period). In addition, we calculated age-standardised rates and rate ratios to compare mental health-related healthcare service utilisation before and during the first two years of the COVID-19 pandemic, stratified by year, sex, age and condition.Results By late 2020, except for emergency department visits, utilisation of healthcare services recovered to prepandemic levels. Between 2019 and 2021, the monthly average rate for overall mental health-related outpatient physician visits, emergency department visits and psychotropic drug dispensations increased significantly by 24%, 5% and 8%, respectively. Notable and statistically significant increases were observed among 10–14 year-olds (44% in outpatient physician visits, 30% in emergency department visits, 55% in hospital admissions and 35% in psychotropic drug dispensations) and 15–19 year-olds (45% in outpatient physician visits, 14% in emergency department visits, 18% in hospital admissions and 34% in psychotropic drug dispensations). Additionally, these increases were more prominent among females than males, with some variation for specific mental health-related conditions.Conclusions The increase in mental health-related healthcare service utilisation and psychotropic drug dispensations during the pandemic likely reflects significant societal consequences of both the pandemic and pandemic management measures. Recovery efforts in British Columbia should consider these findings, especially among the most affected subpopulations, such as adolescents.
Michael Christian Leitner, Michael Christian Leitner, Michael Christian Leitner
et al.
IntroductionA significant number of Restitution Training (RT) paradigms claim to ameliorate visual field loss after stroke by re-activating neuronal connections in the residual visual cortex due to repeated bright light-stimulation at the border of the blind and intact fields. However, the effectiveness of RT has been considered controversial both in science and clinical practice for years. The main points of the controversy are (1) the reliability of perimetric results which may be affected by compensatory eye movements and (2) heterogeneous samples consisting of patients with visual field defects and/or visuospatial neglect.MethodsBy means of our newly developed and validated Virtual Reality goggles Salzburg Visual Field Trainer (SVFT) 16 stroke patients performed RT on a regular basis for 5 months. By means of our newly developed and validated Eye Tracking Based Visual Field Analysis (EFA), we conducted a first-time full eye-movement-controlled perimetric pre-post intervention study. Additionally, patients subjectively rated the size of their intact visual field.ResultsAnalysis showed that patients’ mean self-assessment of their subjective visual field size indicated statistically significant improvement while, in contrast, objective eye tracking controlled perimetric results revealed no statistically significant effect.DiscussionBright-light detection RT at the blind-field border solely induced a placebo effect and did not lead to training-induced neuroplasticity in the visual cortex of the type needed to ameliorate the visual field size of stroke patients.
Spandana Devabhaktuni, Prajakta Patkar, V Pooja
et al.
Hepatic encephalopathy (HE) is an important and potentially life threatening complication in alcoholic patients with decompensated liver function that develop even as they continue drinking. Delirium tremens, on the other hand, is an acute condition resulting from alcohol abstinence in a person dependent on alcohol, making it a life threatening diagnosis that requires intensive care and successful management of the withdrawal. Often in medical wards, these two conditions are mistaken and so is the management plan confused with each other. Making the right diagnosis early on during the hospital course is extremely important in these critical conditions so as to make an appropriate schedule for treatment and a better outcome for the same. A case series of patients who presented with a diagnostic dilemma is reported. Clinical examinations, diagnostic tools to measure the levels of ammonia and liver function tests and hemogram, West Haven criteria and Child–Pugh grading, and clinical scales of these patients are reported. Increased levels of ammonia were present in all the cases. The subtle similarities in the presentation of the two conditions often make it confusing for the clinician to distinguish between them. Using a simple test of measuring ammonia levels in the blood helps in such situations. The detection of raised levels of ammonia in cases of chronic liver disease helps in not just the diagnosis but also is an important prognostic indicator for development of HE.
Comprehensive analysis of the mammalian transcriptome has revealed that long non-coding RNAs (lncRNAs) may make up a large fraction of cellular transcripts. Recent years have seen a surge of studies aimed at functionally characterizing the role of lncRNAs in development and disease. In this review, we discuss new findings implicating lncRNAs in controlling development of the central nervous system (CNS). The evolution of the higher vertebrate brain has been accompanied by an increase in the levels and complexities of lncRNAs expressed within the developing nervous system. Although a limited number of CNS-expressed lncRNAs are now known to modulate the activity of proteins important for neuronal differentiation, the function of the vast majority of neuronal-expressed lncRNAs is still unknown. Topics of intense current interest include the mechanism by which CNS-expressed lncRNAs might function in epigenetic and transcriptional regulation during neuronal development, and how gain and loss of function of individual lncRNAs contribute to neurological diseases.