Neurology Asia

A case of primary Sjögren syndrome masquerading as post-COVID Bickerstaff encephalitis

Shawn Zhi Zheng Lin — 2024-04-02

We present a case of acute external ophthalmoplegia, hypersomnolence, and ataxia occurring 5 days after an episode of SARS-CoV-2 upper respiratory tract infection. The patient’s serum returned positive for anti-GD1a antibodies. Guided by precedent cases, she was empirically started on a course of intravenous (IV) immunoglobulin for possible para-infectious Bickerstaff brainstem encephalitis (BBE). However, she failed to respond and subsequently developed autoimmune hemolytic anemia as well as renal tubular acidosis (type 1). Corroborative history from her family elucidated constitutional and sicca symptoms and she was eventually diagnosed with primary Sjögren syndrome (pSS) complicated by brainstem and cerebellar involvement. She was treated with IV cyclophosphamide and rituximab, after which her neurological deficits completely resolved at two months.

Adult-onset Krabbe disease manifesting as Charcot- Marie-Tooth disease

Jin San Lee — 2024-04-02

Krabbe disease (KD) is a progressive lysosomal storage disorder characterized by the deficiency of β-galactocerebrosidase (GALC). It mainly manifests as central nervous system involvement, but peripheral nervous system damage is also found. Although it can appear as a widespread neuropathy, it is very rare to manifest in a form similar to Charcot-Marie-Tooth disease (CMT). A 34-year-old woman presented with progressive gait disturbance and foot deformity. There were no other medical or family history of abnormalities. Nerve conduction studies showed demyelinating neuropathy, and brain MRI showed white matter hyperintensities. Sequencing of PMP22 gene was normal, followed by next-generation sequencing (NGS). Potential compound heterozygous variants in the GALC gene were found; additionally a decrease in GALC enzymatic activity was confirmed, and KD was diagnosed. Although CMT has been previously diagnosed through a single genetic test, since the introduction of NGS, various genetic mutations have been identified in patients suspected of having CMT. In addition to the phenotypes mainly found in KD, other unusual phenotypes have also been found. In this case, we identified a unique clinical phenotype similar to CMT in a KD patient. We also confirmed the clinical usefulness of NGS by demonstrating in a KD patient diagnosed through NGS, who was not identified by conventional genetic mutation testing.

The effect of valproate on dystonic movement in a moyamoya patient: A case report

Hyeyeon Chang — 2024-04-02

Moyamoya disease (MMD) is a progressive cerebrovascular disorder caused by narrowing of the arteries located at the base of the brain in the basal ganglia. Dystonia is a relatively rare symptom of MMD, and little is known about the treatment of this symptom in MMD patients. We report a case of dystonia in an MMD patient that was alleviated after valproate treatment. A 57-year-old female patient with MMD presented with new-onset dystonia of the left upper extremity and left hemifacial spasm. Although she already suffered from mild cognitive dysfunction, there was no exacerbation when dystonia presented. She was treated with valproate 300 mg b.i.d, and the symptoms were alleviated. We discuss the efficacy of valproate in terms of anatomy and neurotransmitters. In addition, the patient’s symptoms are similar to those associated with LGI-1 encephalitis but are distinguished by the progression of the disease.

The intronic variant of SATB2 gene observed in an Indian Glass syndrome family

Pradeepkumar Murugasamy — 2024-04-02

The Glass syndrome is a rare genetic disorder that is associated with a multisystem disorder due to a SATB2 gene mutation. The intellectual development delay and the delay in speech are the predominant characteristics of the disorder. The reports on Glass syndrome are very few and have not been reported in India. In the present study, we report the Glass syndrome disorder in an Indian mother and her child, both affected by the same likely pathogenic mutation c.1741-2A>C intronic variant at intron 11 of the SATB2 gene. The mutation was observed as a heterozygous and autosomal dominant missense mutation through focused exome sequencing analysis. The variant identified has not been observed in the general population, and the clinical features like cleft palate, speech delay, and intellectual delay match the causative mutation. The present study is novel in exhibiting the intronic variant and identifying Glass syndrome in the Indian population.

A case of pituitary apoplexy presented with isolated complete oculomotor nerve palsy

Sumonthip Leelawai — 2024-04-02

The oculomotor nerve (CN3) innervates four extra-ocular muscles and contains parasympathetic fibers controlling pupillary light reflex (PLR). CN3 palsy with impaired PLR or complete CN3 palsy usually suggests a compressive lesion against the CN3 because the parasympathetic fibers located superficially on the cranial nerve trunk are affected. A cerebral aneurysm originated from posterior communicating artery, posterior cerebral artery or superior cerebellar artery is a common cause of isolated complete CN 3 palsy. Here, we reported a less common intracranial lesion causing isolated complete CN3 palsy for which the preceding recurrent temporal headaches before the CN3 palsy assisted the neurological localization.

Unilateral thrombosis of dominant internal jugular vein presenting with benign intracranial hypertension

Ranchini Murgan — 2024-04-02

Idiopathic intracranial hypertension is defined as an elevation of intracranial pressure (ICP) with no identifiable aetiology. The term ‘pseudotumor cerebri’ or BIH, was commonly used in the past for idiopathic intracranial hypertension, but is now used to describe the chronic elevation of ICP regardless of its aetiology and is further divided into primary (idiopathic intracranial hypertension) and secondary forms. We report a rare case of BIH secondary to unilateral dominant internal jugular vein thrombosis.

Predictive value of fibrinogen for early neurological deterioration in large-artery atherosclerotic cerebral infarction

Junjie Lei — 2024-04-02

Background & Objective: To evaluate the predictive value of fibrinogen at admission for early neurological deterioration (END) in patients with large artery atherosclerotic (LAA) stroke without reperfusion therapy. Fibrinogen, a glycoprotein crucial for clotting, is associated with worse outcomes in ischemic stroke patients. While its connection with thrombolytic therapy’s prognosis is recognized, its predictive role for non-thrombolytic-treated patients is less clear. The objective of this study is to evaluate the predictive value of fibrinogen at admission for early neurological deterioration (END) in patients with large artery atherosclerotic (LAA) stroke without reperfusion therapy.

Methods: This retrospective case-control study included consecutive inpatients with LAA stroke admitted within 72 h of onset at the Fifth Affiliated Hospital of Sun Yat-Sen University between January 2021 and December 2021. An increase of >2 in the National Institutes of Health Stroke Scale (NIHSS) within 7 days after admission was defined as END.

Results: This study included 179 patients (121 males); the mean age was 62.67±13.51 years. There were 42 and 137 patients in the END and non-END groups. The NIHSS score at admission was higher in the END group than in the non-END group, the fibrinogen levels were higher, and the uric acid levels were lower (all P<0.05). NIHSS at admission (OR=1.086, 95%CI: 1.001-1.179), fibrinogen levels (OR=2.182, 95%CI: 1.286- 3.702), and uric acid levels (OR=0.995, 95%CI=0.990-0.999) were independently associated with END. Receiver-operating characteristic curve analysis suggested that the sensitivity, specificity, and area under the curve for fibrinogen for END were 62.9%, 78.1%, and 0.730 (95% CI: 0.532-0.828, P<0.009), respectively.

Conclusions: Elevated fibrinogen is independently associated with END in patients with LAA stroke without reperfusion therapy.

Investigation of telomere length in young age ischemic stroke patients

erhan argis — 2024-04-02

Background & Objective: Telomere length is frequently accepted as a marker of biological aging. Various studies examine the relationship between telomere length, accepted as a marker of biological aging, and stroke, but this relationship has not been clearly demonstrated. The objective of this study is to determine whether short DNA telomere length is an independent risk factor for stroke.

Methods: Our study examined telomere length in young patients with ischemic stroke. The study included 60 patients with a history of ischemic stroke at a young age within the last 3 years and a control group consisting of 40 volunteers with similar age, gender, and disease history defined as risk factors for stroke.

Results: In our study, the mean telomere length of the patient group was significantly higher than the mean telomere length of the control group. However, the telomere length of the patients in the study did not show a significant difference between socio-demographic and risk factors defined for ischemic stroke.

Conclusion: Our study is very important in being the first to show such a relationship between telomere length and young age ischemic stroke. The low sample size may partially explain this result compared to other studies, as well as the study’s design, the study population’s age, ethnicity, and methods of studying telomere length. More studies with a larger sample size with younger patients are needed to better understand the relationship between telomere length and stroke in the future.

A comparison of in-hospital stroke and community- onset stroke outcomes after endovascular thrombectomy at a tertiary level hospital in Taiwan

Kuei-Ming Lin — 2024-04-02

Background: While acute-phase thrombectomy is a recognized treatment for main cerebral artery occlusion, variability exists in outcomes for in-hospital stroke and community-onset stroke patients undergoing endovascular thrombectomy. This study investigates the prognostic differences between in-hospital stroke and community-onset stroke patients in an Asian context, with a focus on the impact of patient transfer processes on treatment outcomes.

Methods: Data were collected from in-hospital stroke patients who underwent endovascular thrombectomy in a tertiary medical center between January 2017 and December 2020. Propensity score matching with a ratio of 1:4 was performed to compare in-hospital stroke and community-onset stroke patients based on sex, age, NIHSS, and occluded vessel location.

Results: The study included 20 in-hospital stroke and 80 community-onset stroke patients, with no significant difference in successful recanalization rates, complications, mortality rates, and NIHSS and mRS scores between the groups. The community-onset stroke group had longer times to treatment, particularly among transferred patients. A high proportion of in-hospital stroke patients had undergone surgery before their stroke, and a greater incidence of heart failure was noted in this group.

Conclusion: Despite pre-stroke surgical treatments and a higher rate of heart failure in in-hospital stroke patients, prompt endovascular thrombectomy resulted in comparable outcomes to community- onset stroke patients. The study underscores the importance of reducing treatment times, especially for transferred patients, to improve stroke care efficacy.

Prevalence of symptomatic acute cerebral infarction among patients with COVID-19 and D-dimer as a predictor of cerebral infarction

Recep Dönmez — 2024-04-02

Objectives: This study sought to investigate the frequency of symptomatic acute cerebral infarction (sACI) among patients with novel coronavirus (COVID-19) disease and the predictive value of laboratory parameters such as D-dimer and neutrophil-to-lymphocyte ratio (NLR) in sACI.

Methods: This retrospective case-control study analyzed the data of 2,378 patients with COVID-19 registered in our database between April 1, 2020 and November 30, 2020. Of these patients, a total of 119 subjects were included in the study, including 31 COVID-19 patients with sACI (patient group) and 88 randomly selected COVID-19 patients without sACI (control group). Categorical variables were compared using Chi-square test and predictive value of the variables was analyzed using receiver operating characteristics (ROC) curve analysis.

Results: Thirty one (1.30%) of 2,378 COVID-19 patients had sACI. Mann-Whitney U test showed that median D-dimer, neutrophil and NLR values were significantly higher in the sACI group compared to the control group (p = 0.004, p < 0.048 and p = 0.007, respectively). ROC analysis yielded the following areas under the ROC curve: D-dimer = 0.674 (95% CI, 0.569-0.779), NLR = 0.663 (95% CI, 0.559-0.767) and neutrophils = 0.620 (95% CI, 0.509-0.73).

Conclusion: The results of the present study showed that elevated D-dimer levels can be used as a predictor of sACI in COVID-19 patients.

The effect of tracheotomy timing on short- term prognosis in hypertensive intracerebral haemorrhage patients after craniectomy: a retrospective analysis of early vs late intervention

Xiaolei Li — 2024-04-02

Objective: The present study aimed to compare the clinical outcomes and short-term prognosis in patients with hypertensive intracerebral haemorrhage (HICH) with basal ganglia haematoma volume ≥ 60 mL who underwent early tracheotomy versus late tracheotomy post-craniectomy.

Methods: A retrospective analysis was conducted based on the data of 102 patients with basal ganglia haematoma volume ≥ 60 mL after craniectomy between 2016 and 2021. Patients were divided into two groups: early tracheotomy and late tracheotomy. This study evaluated the effect of early tracheotomy on prognosis within 90 days and the impact of tracheotomy timing on overall survival in patients with HICH.

Results: Patients in the early tracheotomy group showed a significant reduction in duration of ventilation and intracranial pressure (ICP) at 24 hours (post-tracheotomy) compared to those in the late tracheotomy group. Multivariable logistic regression indicated that late tracheotomy after craniectomy, old age, Glasgow Coma Scale (GCS) ≤ 6, large haematoma volume, and pneumonia after tracheotomy were risk factors for poor prognosis within 90 days in patients with HICH undergoing tracheotomy postoperatively. In terms of the impact of tracheotomy timing on overall survival in patients with HICH, 46 patients died within a follow-up period of 90 days; 19 in the early tracheotomy group (overall survival rate 62.7%), and 27 in the late tracheotomy group (overall survival of 47.1%).

Conclusions: Early tracheotomy significantly improved the short-term prognosis of patients with HICH, with a higher overall survival rate compared to late tracheotomy within 90 days of illness.

Angong niuhuang pill improves the neurological function of younger patients with basal ganglia and cerebral lobe intracerebral hemorrhage: A randomized controlled trial

Weiliang Chen — 2024-04-02

Background & Objective: Spontaneous intracerebral hemorrhage (SICH) is one of the stroke forms with the highest disability and mortality rates and significant differences in prognosis among patients with different locations of SICH. Angong Niuhuang Pill (ANP) 安宫牛黄丸 is one of the most well-known traditional Chinese patent medicines used in the clinical emergency treatment of cardio-cerebrovascular diseases. This prospective study was performed to determine the therapeutic effect of ANP in different locations of SICH.

Methods: Patients with basal ganglia(n=81) and cerebral lobe (n=67) hemorrhage were randomly assigned into two groups: the standard medical management (SMM) group and the combined ANP as well as medical management group (ANP group). Fisher exact test and Mann- Whitney U test were used for comparing the differences between two groups. Primary and secondary outcomes were the 6-month modified Rankin Scale (mRS) scores and the 2-week Brunnstrom stage ratings.

Results: For patients with basal ganglia hemorrhage and cerebral lobe hemorrhage, there were no significant differences observed between the ANP group and the SMM group in terms of patient age (53.1±5.3 vs 52.7±6.4; 54.7±4.8 vs 52.7±5.9), sex (male:64.3% vs 53.8%; 63.6% vs 58.8%), body mass index (25.1±2.1 vs 24.2±2.6; 25.6±2.0 vs 25.0±2.4), mean hematoma volume (17.1±6.6 vs 18.6±5.7; 18.4±7.4 vs 18.9±6.0), as well as the proportions of hypertension (88.1%vs71.8%; 90.9% vs 76.5%), alcoholism (40.5% vs 51.3%; 54.6% vs 41.2%), smoking (40.5% vs 38.5%; 36.4% vs 38.2%), and diabetes mellitus (21.4% vs 18%; 12.1% vs 17.7%). The proportion of basal ganglia hemorrhage patients with a 6-month mRS score of 0-2 in the ANP group was significantly higher than that in the SMM group (26.2% vs. 2.6%, P=0.004), but it was not significantly improved in patients with cerebral lobe hemorrhage (57.6% vs 38.2%, P=0.145). The 2-week Brunnstrom stage ratings of patients with basal ganglia hemorrhage were significant difference (P=0.048). But for patients with cerebral lobe hemorrhage, there was no significant difference (P=0.164). The incidence of liver dysfunction, renal dysfunction, gastrointestinal dysfunction, hypothermia and allergy in the two groups of patients was not significantly different.

Conclusions: ANP has different therapeutic effects on different locations of SICH, and has the most obvious effect on improving the long-term neurological function of patients with basal ganglia hemorrhage.

Use of CALLY index to predict aneurysmal subarachnoid hemorrhage patient outcome

Umut Mutlucan — 2024-04-02

Background & Objective: Aneurysmal subarachnoid hemorrhage (aSAH) is a condition linked to elevated mortality and morbidity rates. Despite limited knowledge of the exact mechanism in aSAH patients, systemic inflammation is thought to have a significant role in cerebrovascular disease. The CALLY index is a prognostic marker utilized in many diseases, derived from parameters such as CRP, albumin, and lymphocytes. Nevertheless, there is limited research on its implementation in aSAH patients. This study aimed to investigate the CALLY index’s prognostic usefulness in aSAH patients.

Methods: The research cohort comprises patients who attended a tertiary teaching and research hospital’s emergency department between January 1st, 2021, and January 1st, 2022, with a confirmed diagnosis of aneurysmal rupture. Basic demographic data and associated comorbidities of the cohort, in addition to the CALLY index derived from CRP, albumin, and lymphocyte levels, were documented. A comparison of the effects of investigations and data on in-patient mortality between the groups was conducted.

Results: A total of 190 patients who met the inclusion criteria participated in the study. Patients with mortality were observed to have significantly lower CALLY Index scores than those in the other group (1.940 vs. 8.805). Regression analysis showed that mortality could be predicted based on the CALLY index (OR 0.393, 95% CI 0.1511-1.058, p=0.058). An AUC of 0.752, sensitivity of 78.2, specificity of 59.8 [p<0.001] was achieved by the optimal value for CALLY index.

Conclusion: Based on the findings of this study, it can be inferred that CALLY index is a simple marker which can serve as an indicator of mortality in aSAH patients.

Accuracy and reliability of wristband smartwatch-based estimation of circadian rhythm of heart rate in stroke patients

Lin Yao — 2024-04-02

Background & Objective: Stroke has a high incidence, disability, and mortality rate, which has a serious impact on the patients’ quality of life. Heart rate (HR) is valuable in the prognostic assessment of stroke patients. Continuous HR tracking helps to detect abnormal indicators and provide interventions timely to avoid disease progression. However, the cuff-based or electrode-based HR monitoring tools commonly used in clinic are not suitable for continuous monitoring in daily life. The aim of this study was to verify the accuracy and reliability of a wristband smartwatch in monitoring HR over 24-hour in stroke patients, including in terms of the circadian rhythm characteristics of HR.

Methods: 25 stroke patients underwent 24-hour HR monitoring by wearing a smartwatch and a clinical monitor. We use ambulatory blood pressure monitors and bedside monitors as the gold standard for clinical HR monitoring. The degree of association between the two measurements was compared using Pearson’s correlation coefficient. Bland-Altman analysis showed the accuracy of the smartwatch in HR monitoring. Intraclass correlation coefficients (ICC) and coefficients of variation (CV) were used to verify the reliability of the wristband smartwatch for repeated measurements.

Results: A total of 625 heart rate pairs were acquired. The smartwatches had an average error of 0.816 bpm in 24-hour, with no difference from standard monitors (P>0.05), indicating good accuracy. The intraday repeated measures ICC was 0.969 and the interday repeated measures ICC was 0.788, indicating good reliability.

Conclusions: The smartwatch is acceptable in detecting 24-hour ambulatory HR in stroke patients, and in the future, long-term HR monitoring with diurnal variations can be performed in daily life.

Exploring predictors of aphasia recovery: A 6-month follow-up study in Bengali-speaking stroke patients using the Western Aphasia Battery

snigdhendu pal — 2024-04-02

This study investigated the recovery of language dysfunction in 50 consecutive stroke patients over a 6-month period, employing the Bengali adaptation of the Western Aphasia Battery (B-WAB) for language assessment. The cohort, with a mean age of 58.16 year, predominantly presented with Broca’s aphasia (36%) at the initial evaluation, and moderate aphasia was prevalent (56%). Aphasia severity was quantified using Aphasia Quotient (AQ) scores, with a mean AQ of 52.16 at the first assessment. Notably, 80% of participants exhibited ischemic strokes, and cortical stroke was the most common type (44%). Follow-up assessments revealed a statistically significant improvement in mean AQ at 6 months (63.17), with 64% demonstrating ‘some recovery,’ 8% achieving ‘complete recovery,’ and 28% exhibiting ‘no recovery.’ Improvement was most notable in single-word comprehension and repetition. Factors influencing recovery were examined, revealing that male patients experienced better recovery, and the interval between the index event and the first assessment significantly impacted outcomes. Logistic regression analysis identified AQ at first assessment and the site of stroke (cortical vs. cortico- subcortical vs. pure subcortical) as significant predictors of aphasia recovery. The study contributes valuable insights into the dynamics of aphasia recovery post-stroke, emphasizing the importance of early assessment and highlighting specific factors influencing the rehabilitation process.

Tubridge flow diverter for the treatment of recurrent cerebral aneurysms

Li Zhao — 2024-04-02

Background & Objective: The Tubridge flow diverter is a commonly used device in China for reconstructing the parental artery and occluding complex intracranial aneurysms. However, there is limited experience with the device in treating recurrent intracranial aneurysms. The purpose of this study is to assess the safety and effectiveness of the Tubridge flow diverter in treating recurrent single- coiling aneurysms.

Methods: The clinical records of patients with recurrent intracranial aneurysms who were treated with a Tubridge flow diverter were reviewed to show the therapeutic process, occlusion rate, and clinical outcomes associated with this treatment method.

Results: Five patients with recurrent aneurysms of the internal carotid artery after singe coiling were included in the study. The recurrent aneurysmal sac had a mean length and width of 8.34/4.30 mm. All five Tubridge flow diverters were implanted without any unfold failure. The last angiographic follow-up showed a complete occlusion rate of 100%. Five branch arteries were covered, and only one branch artery disappeared during follow-up. No cases of cerebral infarction or intracranial hemorrhage were found among the patients.

Conclusions: Our initial findings indicate that the Tubridge flow diverter could be a reliable and successful method for treating recurring single-coil aneurysms. We observed that the branch arteries were well-preserved, and no patients experienced cerebral infarction or hemorrhage. However, further research is necessary to establish clear indications and potential complications through a multicenter randomized controlled trial with long-term follow-up.

Adults’ knowledge levels of and attitudes toward epilepsy: a cross-sectional study in Samsun Türkiye

Vedat Kayar — 2024-04-02

Background & Objective: Epilepsy is not only a common neurological disorder, but also a stigmatising cause of psychosocial difficulties and discrimination. This study aimed to evaluate adults’ knowledge levels and attitudes toward epilepsy.

Methods: This cross-sectional study was conducted between August and September 2022 from four family healthcare units in Samsun, Türkiye. In the questionnaire, a personal information form, the Epilepsy Knowledge Scale (EKS), and the Epilepsy Attitude Scale (EAS) were used.

Results: Four hundred and six people participated in this study. The mean age of the participants was 39.4±13.6 years, and 54.2% were women. The mean EKS score was 9.9±3.1 (Maximum 16), and the mean EAS score was 56.8±8.9 (Maximum 70). University graduates (p=0.001), participants familiar with individuals with epilepsy (p<0.001), with epilepsy in the family (p<0.001), who had witnessed epileptic seizures (p<0.001), who had previously heard about epilepsy (p<0.001), and who had read about epilepsy (p<0.001) registered higher mean epilepsy knowledge scores. Participants over 35 (p=0.002), unmarried individuals (p<0.001), university graduates (p<0.001), the employed (p=0.008), participants with children (p<0.001), who knew individuals with epilepsy (p=0.016), with epilepsy patients in the family (p=0.023), who had witnessed epileptic seizures (p<0.001), who had previously heard of epilepsy (p=0.012), and who had read about epilepsy (p<0.001) registered higher mean attitudes to epilepsy scores. Positive attitudes toward epilepsy increased according to the level of knowledge of epilepsy (r=0.387; p<0.001).

Conclusion: The participants from Samsun, Türkiye exhibited moderate levels of knowledge about epilepsy and positive attitudes toward the disease. Increasing levels of knowledge were associated with increasingly positive attitudes toward epilepsy.

Evaluation of midwifery students’ health fatalism, knowledge, and attitudes toward patients with epilepsy in Eastern Turkey

özlem koç — 2024-04-02

Objective: This study was conducted to determine the relationship between midwifery students’ health fatalism, epilepsy knowledge, attitudes, and some sociodemographic variables.

Methods: The descriptive cross-sectional study was conducted with 270 midwifery department students who were studying at a state university and who agreed to participate in the study in eastern Turkey during the 2021–2022 academic year. The data were collected using a Sociodemographic Information Form, the Health Fatalism Scale (HFS), the Epilepsy Knowledge Scale (EKS), and the Epilepsy Attitude Scale (EAS).

Results: The midwifery students had total mean scores of 49.69±13.25, 7.71±3.69, and 54,87±8.13 for the HFS, EKS, and EAS, respectively. It was found that those who had social contact with epilepsy patients had significantly higher EKS and EAS scores, but no correlation with HFS.

Conclusion: The study of midwifery students in Eastern Turkey shows that close contact with epilepsy patients is associated with better knowledge of and attitude to epilepsy, although the high health fatalism remains.

Clinical profile and prognosis of COVID-19 patients with neurological manifestations: A city-wide cross- sectional study in Iran

Hani AziziKia — 2024-04-02

Background & Objective: In this study, we aimed to evaluate past medical and social history, initial symptoms, laboratory values, clinical course, and outcome of COVID-19 patients with neurological manifestations in Shahroud, Iran.

Methods: In this cross-sectional study, data from all registered COVID-19 patients in Shahroud during March 2020 to July 2021 (n=30,228) were initially reviewed in terms of the prevalence of neurological symptoms. Additionally, the data of COVID-19 patients admitted to Shahroud’s hospital (n=8,412) was evaluated in details according to the clinical profile, socio-demographic characteristics, laboratory findings, and in-hospital outcomes. Data were compared between COVID-19 patients with and without neurological manifestations. Predictive factors of ICU admission and mortality in COVID-19 patients with neurological manifestations were also evaluated.

Results: Fever, chills, anorexia, myalgia, arthralgia, nausea, vomiting, cough, dyspnea, diarrhea and abdominal pain were significantly more common among COVID-19 patients with neurological symptoms compared to COVID-19 patients without such symptoms. Furthermore, smoking, drug abuse and history of underlying diseases were significantly more prevalent among the former group. Patients with neurological symptoms were more likely to be admitted to the hospital and ICU and had higher mortality rates. In terms of laboratory findings, hemoglobin, hematocrit, platelet count, and albumin levels were significantly lower in the patients with neurological symptoms. Age ≥ 50 years and history of underlying diseases were associated with increased ICU admission in COVID-19 patients with neurological manifestations.

Conclusions: The following strategies could prove beneficial for COVID-19 patients: (i.) reduction of smoking and substance abuse, (ii.) close monitoring of more symptomatic patients and patients with a history of underlying diseases for neurological manifestations, (iii.) providing appropriate intensive care for older patients and those with underlying diseases who have neurological manifestations and (iv.) early detection of anemia, thrombocytopenia, and hypoalbuminemia.

Comparison of emergency consultations of patients with neurologic complaints before and during COVID-19 pandemic in a single tertiary hospital in Makati City, Philippines

Julie Anne Gamboa — 2024-04-02

Background & Objective: COVID-19 forced us to develop adaptive ways to the new normal of healthcare delivery. Neurology has one of the most diverse types of patients who require urgent, prolonged and multidisciplinary care. This study aimed to understand the impact of the unprecedented community lockdown among patients with chronic and new onset neurologic conditions on emergency room (ER) utilization in a single tertiary hospital in Makati City, Philippine.

Methods: We retrospectively examined all consecutive neurology referrals made at the ER from March to August 2020 and compared them with a control group consisting of all ER neurology referrals during the same months in 2019.

Results: There was a 45% decline in the volume of referral to neurology service at the ER during the first 6 months of the lockdown period. There were fewer females who sought emergency neurologic care (p=0.019). The average age of patients increased from 55.5 years (σ=19.9) in 2019 to 59.5 years (σ=18.4) in 2020 (p<0.001). The top three chief neurologic complaints in 2019 were dizziness (17.7%), motor weakness (14.1%), and headache (13.2%). In 2020, the top three neurologic complaints where motor weakness (19.0%), decreased level of consciousness or loss of consciousness (13.2%), and dizziness (11.2%), (p<0.001). The average time from symptom onset to ER admission in 2019 was 5.1 days (σ=23.9) which increased to 8.4 days in 2020(σ=28.1), (p<0.001). The proportion of patients with no co-morbidities at the ER decreased from 27.6% in 2019 to 17.0% in 2020 (p<0.001). Patients with pre-existing cardiovascular diseases, endocrine diseases, pulmonary diseases, renal diseases, cancers, and others have significantly increased (p<0.05). However, the increase in the proportion of patients with pre-existing neurological disorders (p=0.143) was not statistically significant (p>0.05). The only pre-existing neurologic conditions with significantly increased in proportion was stroke (p=0.010). Among new onset neurologic diagnoses, headache and facial pain (p<0.001) and peripheral and other neuropathies (p=0.005) significantly decreased in proportions while proportions of cases with new stroke or vascular pathology (p<0.001) and encephalopathy (p=0.003) have significantly increased. ER dispositions showed a significant (p<0.001) decrease in proportions of patients who were admitted, discharged, and transferred to hospital of choice; while patients who were discharged against medical advice and who died at the ER have significantly increased.

Conclusion: The initial six months of community lockdown during COVID-19 pandemic caused a significant change in the characteristics of patients referred to neurology for emergency care. These changes provide us a new perspective on how to better deliver optimal neurologic care to these diverse patients especially during times of pandemic.

Evaluation of cognitive functions and dementia two years after COVID-19 infection

Hatice Yuksel — 2024-04-02

Background: The Coronavirus disease 2019 (COVID-19) causes high morbidity and mortality in the acute period. Some patients with COVID-19 continue to have symptoms for a long time. However, data on the long-term effects of COVID-19, particularly on cognitive disorders is scarce. We aimed to evaluate cognitive functions and dementia in patients who survived two years after discharge from hospital due to acute covid-19 infection.

Methods: Two hundred and five patients who had neurological symptoms during index hospitalization for COVID-19 infection were evaluated two years after discharge, and 64 patients were included in the study. According to cognitive assessments, patients were grouped as having normal cognitive levels (48 patients) or impaired cognitive levels (16 patients).

Results: The impaired cognitive level was found in 16 (25.0%) of patients who underwent cognitive tests. Age, the pre-existence of neurological comorbidity, mean intensive care unit day, and Beck’s Anxiety Inventory and Beck’s Depression Inventory scores in the impaired cognitive level group were significantly higher than the normal cognitive level group (p:0.001, p:0.013, p:0.015, p:0.004 and p:0.008). The frequency of cognitive impairment in patients who developed altered mental state during hospitalization was 36.0%, while it was 17.9% in patients with normal mental state. Age, the pre-existence of neurological comorbidity, and anxiety were determined as independent risk factors for impaired cognitive level. In addition, we detected new-onset dementia in 8 patients (12.5%).

Conclusion: We found a high frequency of cognitive impairment and new-onset dementia among COVID-19 survivors who developed neurological manifestations during the acute infection phase.

Clinical, neurophysiological and genetic characteristics of Charcot-Marie-Tooth from a research center in northern China

Jingfei Zhang — 2024-04-02

Background & Objectives: Charcot-Marie-Tooth (CMT) disease is a group of hereditary sensorimotor neuropathies with a great variability of genotypes and phenotypes. The aims of the study were to provide a general perspective of the clinical manifestations and the frequency of genetic subtypes in CMT patients from a medical center in Taiyuan, northern China.

Methods: Twenty-eight unrelated CMT patients were enrolled from a research center in northern China according to the CMT diagnosis criteria formulated by De Jonghe et al. in 1998. Then multiplex ligation-dependent probe amplification (MLPA) testing combined with next-generation sequencing (NGS) were performed among 18 of these patients.

Results: PMP22 duplications were identified in 8 patients. In addition, 2 novel mutations were detected in the GJB1 gene (c.236T>C and c.464T>C). According to the American College of Medical Genetics and Genomics (ACMG) standards and guidelines, both two GJB1 mutations were assigned as ‘likely pathogenic’. PMP22 and GJB1 were the most common causative genes in CMT1 and intermediate CMT, respectively. In addition, the first CMTX6 patient with a p.R158H mutation in the PDK3 gene was confirmed in China. Our study further shows that the p.R158H of PDK3 is likely to be a recurrent mutation.

Conclusions: The results have broadened the genetic and clinical spectrums of CMT patients, which can help facilitate the diagnosis of CMT. Despite the increasing popularity of NGS, genetic screening of large cohorts of CMT patients using NGS is still rarely performed in the Chinese population. In CMT we suggest having MLPA for PMP22 as the first tier of study followed by target NGS for those with negative MLPA findings. The deciphering of the target gene candidates can further be guided by electromyographic data.

Prevalence of diabetic neuropathy in nonalcoholic fatty liver disease (NAFLD) patients: A systematic review and meta-analysis

Mohammad Rahmanian — 2024-04-02

Nonalcoholic fatty liver disease (NAFLD) refers to the uncontrolled accumulation of triglyceride (TG) in the liver when the person has no other liver disease etiologies. Among all causes of neuropathy, diabetic neuropathy is the most common one worldwide, and it causes notable morbidity and increases mortality. The prevalence of diabetic neuropathy and NAFLD has been demonstrated in few studies. This study aims to summarize existing data estimating peripheral diabetic neuropathy prevalence among sonographically detected NAFLD patients. We searched PubMed, Scopus, Web of Science, and Google scholar for articles in the English language up until October 2021 for the clinical trials of diabetic neuropathy in NAFLD patients and used the articles for a systematic review and meta-analysis. Seven studies (6,918 patients with type 2 diabetes mellitus (T2DM)) were involved. The prevalence of diabetic neuropathy among T2DM patients with ultrasound (US) detected-NAFLD was 0.48 (95% CI= 0.31-0.65, I2= 99.01%), however it was not significantly different from patients without NAFLD (OR=1.02, 95% CI= 0.89-1.17. p=0.748, I2=81.6%). The prevalence of diabetic neuropathy among T2DM patients with NAFLD is not significantly different from patients without NAFLD.

Vulvodynia prevalence and associated psychosexual problems in middle-aged diabetics at a tertiary care hospital in Pakistan

Amna Nisar — 2024-04-02

Background & Objective: Vulvodynia is a significant clinical disorder in women but it remains a neglected health problem in many societies. The present study was aimed to identify the frequency of vulvodynia in the diabetic and non-diabetic population and its association with common psychosexual problems in the population of Khyber Pakhtunkhwa, Pakistan.

Methods: This study is cross sectional descriptive investigation and conducted in tertiary care hospital (Lady Reading Hospital, Peshawar) in 2018-2019. A total of 75 cases categorized into diabetic and non-diabetic groups were collected under the supervision of qualified gynecologists. Groups were compared on the basis of demographics, symptom frequency, psychological and clinical data, using a pre-designed proforma.

Results: The incidence of vulvodynia in women with type 1 and type 2 diabetes (n = 50) and in the non-diabetic population (n = 25) was 66.6% and 33.3%, respectively. The vulvodynia severity score based on Friedrich`s criteria in diabetes was 80% and in non-diabetes it was 40%. The cotton bud swab test severity index was 80% in diabetes and 40% in non-diabetes. The erythema rating scale score in diabetes was 81% and in non-diabetes it was 39%. Finally, psychological and psychosexual problem frequency in diabetes was 100% and in non-diabetes was 88%.

Conclusions: Women with diabetes had a fourfold risk of vulvodynia up to middle age as compared to non-diabetics in Peshawar, Pakistan. Diabetics with vulvodynia possessed a nine-fold risk of experiencing psychological symptoms of depression (OR = 9.33; 95% Cl 1.0-88.6) and an even higher risk of somatic depression symptoms.

Simultaneous versus consecutive administration of cervical traction and neural mobilization in patients with cervical radiculopathy: A randomized controlled trial

Tahir Masood — 2024-04-02

Background & Objective: Cervical traction and neural mobilization are frequently utilized in the management of cervical radiculopathy. However, there is a paucity of literature concerning the best order of application of these techniques. The aim of this study was to compare the effects of simultaneous and consecutive administration of cervical traction and neural mobilization on pain and function in cervical radiculopathy.

Methods: Thirty patients were randomly assigned to two equal groups: consecutive (CON) and simultaneous (SIM) cervical traction and neural mobilization in this single-blind randomized controlled trial. The inclusion criteria comprised age 20-60 years, unilateral cervical radiculopathy ≥ 6 months, and positive upper limb neural tension tests of radial, median or ulnar nerve, and positive Spurling test. Outcome measurement tools were numeric pain rating scale, cervical goniometry, neck disability index, and short-form health survey. Data was analyzed with SPSS 23.

Results: Significant improvement was evident in all parameters in CON after 1-week rehabilitation (P≤0.001 for seven of the ten variables). Similarly, all parameters showed significant improvement in SIM (P≤0.001 for all variables except mental component score of SF-12 with P<0.05). After rehabilitation, SIM was significantly better with respect to pain (P<0.05), flexion-extension mobility (P<0.001), and quality of life (P<0.01). No differences were found in other variables.

Conclusion: Simultaneous use of cervical traction and neural mobilization resulted in significantly better outcomes with regards to pain, flexion-extension mobility, and quality of life. The two groups performed similarly on other outcome measures.

Risk factors for white matter lesions in migraine patients: Insights for prevention and management

gülcan göçmez yılmaz — 2024-04-02

Background & Objective: White matter lesions (WML) are commonly observed in cerebral Magnetic Resonance Imaging scans of individuals with migraine. However, the exact causes of these lesions in migraine patients remain unclear. This study aims to identify and assess risk factors associated with WML in migraine patients.

Methods: Our study included 63 migraine patients with and 64 patients without WML. We compared clinical characteristics and laboratory data between the two groups, including age, gender, age of migraine onset, duration of migraine disease, history of cigarette smoking, presence of hypertension, presence of an aura, attack frequency, photophobia and phonophobia.

Results: Multivariate analysis revealed that the risk of developing WML increased two times with age (odds ratio [OR] = 2.00; 95% confidence interval [CI] for OR = 1.24–3.19) and was nearly five times higher in women (OR = 4.92; 95% CI = 1.14–21.11). Compared to patients experiencing a single attack a month, those with 2-5 attacks per month had a seven-fold higher risk, while those with more than five attacks per month had a nine-fold higher risk of developing WML (OR = 7.82; 95% Cl = 1.40–43.64, 9.17; 95% CI = 1.59–52.54). Additionally, a 100-unit increase in TG levels doubled the chances of developing WML (OR = 2.22; 95% CI = 1.23-4.00).

Conclusion: This study identifies age, female gender, attack frequency, and elevated TG levels as significant risk factors for the development of WML in migraine patients. These findings provide insights for the prevention and management of WML in individuals with migraine.

Serum neurofilament level as a biomarker in multiple sclerosis

Huda Qate’a Jabbar — 2024-04-02

Background & Objective: Currently, MS disease activity and neurodegeneration are assessed mainly through clinical evaluation and magnetic resonance imaging. These measures lack sensitivity and specificity, leading to a constant search for a new biomarker. Several markers have been studied, and the most promising to date is the neurofilament. Our objective was to examine the relationship between serum neurofilament levels and multiple sclerosis parameters.

Methods: Fifty-six adults who fulfilled the McDonald’s criteria 2017 for the diagnosis of MS, and forty-four healthy controls were enrolled in this study. Serum samples were collected to assess neurofilament light and heavy chain (NfL & NfH) levels using the ELISA method, the results were compared for MS patients and controls; and were also correlated to the type of MS, disease duration, EDSS (expanded disability status scale), MSSS (MS severity score) and disease activity.

Results: The mean serum NfL and NfH levels for cases were 133.3 pg/ml and 3654.5 pg/ml respectively, which are significantly higher than that for controls (NfL = 80 pg/ml; and NfH = 408.8 pg/ml; p-value < 0.001). There were no significant correlations between serum neurofilament levels and EDSS, MSSS, disease activity, type, and duration.

Conclusions: In our study, we could not find a significant role for the ELISA neurofilament serum level as a biomarker for MS disease activity and severity.

Direct cost of rituximab treatment in multiple sclerosis: A real-world finding from Malaysia

Sutha Rajakumar — 2024-04-02

Background & Objective: Multiple sclerosis (MS) imposes a significant economic burden on the healthcare system. In 2022, more than half of the Neurology budget of Hospital Seberang Jaya was spent on rituximab, an off-label drug for treating MS. Recently, the availability of rituximab biosimilar had provided an opportunity for cheaper treatment alternatives for subsidised patients or patients opting to self-purchase the medication. This study aimed to estimate the clinical outcome and cost of treatment of MS patients on Mabthera (originator) and Truxima (biosimilar).

Methods: A retrospective analysis of MS patients treated with rituximab from April 2018 to April 2023 was performed. Clinical charts and documented adverse events were reviewed. Healthcare costs were estimated based on rituximab treatment, hospitalisation charges, personnel and other diagnostic costs.

Results: Four patients treated with Mabthera and three with Truxima, with follow-up, ranging from 1 to 5 years (median: 3 years), were included. Two relapses occurred during follow-up, whereby one Mabthera and Truxima patient, respectively. Expanded Disability Status Scale (EDSS) score improved in four patients, three patients treated with Mabhtera and one patient treated with Truxima. MR imaging reported no new changes in all the patients and a new lesion in one Truxima-treated patient. The estimated treatment drug cost of Mabthera was USD 7294.62 per patient/year and Truxima USD 3612.90 per patient/year. The total estimated personnel cost for a typical 2-day admission without complication is USD 62.26, the diagnostic cost for a complete blood count and urinalysis is USD 2.37, and the bedding cost is USD 1.29 for a typical two days. The total cost difference in treatment is affected mainly by the rituximab drug cost unless patients with urinary tract infection on day 14 are treated, and the length of stay is prolonged with antibiotics administration.

Conclusion: Our findings showed that Mabthera and Truxima were well tolerated. There is a significant difference in the cost of rituximab (p=0.026), bedding cost (p=0.048), healthcare professional cost(p=0.048) and the total cost (p=0.032) among patients on Mabthera and Truxima. However, as the number of patients treated with Truxima is limited, a longitudinal cohort or multi-centre approach could be carried out.

Study of the association between anemia and prognosis of moderate-to-severe traumatic brain injury

Ruilan Yin — 2024-04-02

Objective: To investigate the impact of admission anemia on the prognosis of patients with moderate- to-severe traumatic brain injury (TBI).

Methods: The clinical data of patients with moderate-to-severe TBI treated in the Department of Intensive Care Unit in our hospital from January 2020 to September 2022 were retrospectively analyzed. The patients were divided into admission non-anemia group (Hb ≥ 100 g/L) and admission anemia group (Hb<100 g/L) based on hemoglobin (Hb) levels. The Glasgow Coma Scale (GCS) score, first blood analysis, arterial blood gas, blood pressure, injury mechanism, pupillary reflex at admission and others were compared, multivariate logistic was used to analyse independent risk factors for patient death.

Results: One hundred and nine patients were included in the study, of which 17 died in the hospital and 52 had anemia at admission. Compared with patients in the admission non-anemia group, patients in the admission anemia group were younger, had lower admission GCS and trauma score (PTS) scores, higher mortality rates, and longer hospital stay (all P<0.05).Univariate analysis showed that moderate-to-severe TBI patients with admission anemia, admission hyperglycemia, GCS<8, PTS<8, abnormal pupillary reflex, and other organ injuries had higher mortality rates (all P<0.05) .Multivariate logistic regression analysis showed that admission anemia (OR=9.383, 95% CI=1.086~81.094, P=0.042), admission pupillary reflex abnormalities (OR=23.121,95% CI=3.680~145.270,P=0.001), and admission hyperglycemia (OR=15.181, 95% CI=2.019~114.160, P=0.008) are independent risk factors for death of Moderate-to-severe TBI patients.

Conclusions: Admission anemia is an independent risk factor for death of moderate-to-severe TBI patients, and it can prolong the length of hospital stay for such patients.

Indicators of abnormal CT Scan findings in clinically mild traumatic brain injury patients

Erwin W Nugraha — 2024-04-02

Background & Objective: Various clinical guidelines have been developed to predict intracranial findings and minimize the unnecessary head CT scans in mild traumatic brain injury (MTBI) patients. However, the most appropriate guideline for routine practices might be highly dependent on the emergency department policies, qualifications of medical staff, and the level of infrastructure availability. This study aims to identify various indicators that can predict abnormal CT scan findings in clinically MTBI patients.

Methods: Our retrospective analytical study included patients diagnosed with MTBI admitted to the Emergency Department of Prof. Dr. R. D. Kandou General Hospital, Manado, Indonesia, from November 2022 to February 2023, age ≥18 years, and having undergone a brain CT scan. Multivariate analyses of several indicators were performed to identify the strongest indicators of abnormal CT scan findings.

Results: Among 112 subjects, abnormal CT scan findings were identified in 38 subjects (33.9%). The proportion of men is greater (63.4%), with a median age of 33 (18-88) years. The most common mechanism was traffic accidents (83.0%). Logistic regression analysis revealed that skull fracture (OR 8.144, 95% CI 3.110-21.326) and signs of skull base fracture (OR 7.059, 95% CI 2.217- 22.475) were the two strongest indicators in predicting abnormal CT scan findings.

Conclusions: Skull fracture and signs of skull base fracture were the two strongest indicators of abnormal CT scan findings in clinically MTBI patients. Therefore, skull X-rays in the setting of limited CT scans and thorough clinical examination are recommended.

MAD2L2 as a novel prognostic biomarker and its correlation with immune infiltrates in glioma

Kaiqin Chen — 2024-04-02

Background: The most common type of central nervous system tumor is glioma, the identification of Glioma biomarkers is essential. MAD2L2, which is abbreviated as MAD2-Like2, collaborates with a number of proteins to carry out numerous essential cellular functions. Uncertain is the role of MAD2L2 in glioma. The role of MAD2L2 expression is examined for the first time in relation to gliomas occurrence and development in this study

Methods: A bioinformatics and clinicopathological analysis, immune infiltration analysis, and enrichment analysis were conducted based on TCGA and additional gene expression analysis. Using ssGSEA and TIMER, the immune response to MAD2L2 expression in glioma was analyzed statistically. This study also analyzed the effect of MAD2L2 overexpression on major chemotherapeutic medicines and the methylation status of glioma patients. CGGA, HPA data analysis, and K-M survival were also utilized to validate the results.

Results: MAD2L2 was a crucial independent prognostic factor for glioma patients. Correlations were found between MAD2L2 expression and age, IDH status, WHO grades and 1p/19q codeletion. MAD2L2 is intimately connected to the DNA replication, transcription, cell cycle, immune system, and signal transduction pathways, as determined by the GSEA. In glioma, The majority of MAD2L2 DNA methylation sites were hypomethylated, and the degree of methylation was associated with patient outcomes. Chemotherapy would benefit MAD2L2 overexpression patients. according to these results. The expression of MAD2L2 was associated with partial immune cell infiltration and co-expressed with immune-related genes and immune checkpoints.

Conclusion: Glioma is characterized by higher MAD2L2 expression, and high MAD2L2 expression is linked with a poor prognosis. MAD2L2 might participate in tumor development by regulating tumor-infiltrating cells inside the TME. MAD2L2 could possibly be an immunotherapeutic target.

Childhood vertigo: A retrospective series of 791 cases

Zülal ÖZDEMİR USLU — 2024-04-02

Background: Vertigo is one of the most common complaints leading to admissions in pediatric neurology clinics. Diagnosis of vertigo in children is often challenging due to limited communication capacity in defining symptoms, the unreliability of neurovestibular investigations in children and the variability of etiologies. The aim of this study is to evaluate clinical and etiological profile of vertigo in childhood and to assess the diagnostic yield of neuroimaging and electroencephalography (EEG).

Methods: All patients under the age of 18 years presented with vertigo to the pediatric neurology outpatient clinic of Ankara Keçiören Research and Training Hospital were included in the study. Demographic data, accompanying symptoms, family history, physical and neurological examination findings, neuroimaging, and EEG results were retrospectively analyzed. The etiological spectrum was also evaluated according to age groups.

Results: A total of 791 patients (female/male=2.1) with a mean age of 13.1 years were included in the study. The most common etiologies were vestibular migraine (27.3%) and psychogenic vertigo (14.9%) in the entire cohort; whereas benign paroxysmal vertigo of childhood was the top diagnosis in children ≤12 years (25%). The most common accompanying symptom was headache (36.7%) which was most frequently associated with vertigo attacks in migrainous patients. In most cases there was no correlation between neuroimaging findings and vertigo. Additionally, the contribution of EEG to the diagnosis was found to be limited.

Conclusion: Most of the childhood vertigo cases can be diagnosed accurately by a detailed medical history, physical and neurological examination. A multidisciplinary approach is essential for evaluating childhood vertigo and all the signs and symptoms accompanying vertigo should be considered while planning further investigations including neuroimaging and EEG.

A novel aptamer agent showed antidepressant function via binding 5-hydroxytryptamine receptor to block re-uptake of 5-HT

zhiding Shao — 2024-04-02

Background & Objectives: Systematic evolution of ligands by exponential enrichment (SELEX) technology was widely used to screen the aptamers that bind the target protein safely and efficiently. Our study aimed to screen aptamers for anti-depression via binding to the 5-HTR to block 5-HT re- uptake.

Methods: The prokaryotic expression plasmid was constructed and the recombinant 5-HT1AR (mice) was expressed and purified. The ssDNA aptamer that bound 5-HT1AR specifically was screened by SELEX (Enzyme-linked Oligonucleotide assay), and the binding sites and relative binding strength of ssDNA were detected. At the same time, ssDNA aptamer inhibitory protein uptake and against depression was verified in cellular level and mouse depression model.

Results: The recombinant 5-HT1AR protein was purified successfully. After 12 rounds of positive screening and 5 rounds of negative screening, four aptamers with high affinity and specificity were obtained and the same epitope was bounded by four aptamers using ELONA (Enzyme-linked Oligonucleotide assay). The uptake of 5-HT was influenced by aptamer 18 in vitro, and the improvement of depression state in mice after intravenous injection of aptamer 18 was proved by tail suspension experiment in mice.

Conclusions: Aptamer is expected to be a new type of antidepressant, which can be used in the treatment of depression.

Very early re-do microvascular decompression for patients with trigeminal neuralgia

Tao Sun — 2024-04-02

Although microvascular decompression (MVD) is the widely recognized surgical option for patient with trigeminal neuralgia (TN), and most patients could receive satisfactory outcome, some patients still complained of severe pain, with culprit vessel omission and incomplete decompression as the commonly mentioned reasons. Here we reported three cases of very early re-do MVD for patients with TN. We found that both artery and vein simultaneous compressed the trigeminal nerve, and tight adhesion was found between the vein and nerve. The artery was totally decompressed, but the vein could not be decompressed without affecting the blood flow due to the severe adhesion, the patients still complained of severe pain after the first surgery. Very early re-do MVD was performed and we totally separated the veins from the nerve. The symptoms of patients disappeared immediately without any complication. No recurrence was found during follow up. We conclude that culprit vein should be retained if possible, rather than sacrificed, and very early reoperation may be a feasible choice for patient with persistent symptom after MVD.