Neurology Commons^™

Fuzzy Logic In Neurosurgery: Predicting Poor Outcomes After Lumbar Disk Surgery In 501 Consecutive Patients, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai

Section of Neurosurgery

Background: Despite a lot of research into Patient selection, a significant number of Patients fail to benefit from surgery for symptomatic lumbar disk herniation. We have used Fuzzy Logic-based fuzzy inference system (FIS) for identifying Patients unlikely to improve after disk surgery and explored FIS as a tool for surgical outcome prediction.
Methods: Data of 501 Patients were retrospectively reviewed for 54 independent variables. Sixteen variables were short-listed based on heuristics and were further classified into memberships with degrees of membership within each. A set of 11 rules was formed, and the rule base used individual membership degrees and their …

Mitochondrial Mislocalization Underlies Abeta42-Induced Neuronal Dysfunction In A Drosophila Model Of Alzheimer's Disease., Kanae Iijima-Ando, Stephen A Hearn, Christopher Shenton, Anthony Gatt, Lijuan Zhao, Koichi Iijima

Department of Biochemistry and Molecular Biology Faculty Papers

The amyloid-beta 42 (Abeta42) is thought to play a central role in the pathogenesis of Alzheimer's disease (AD). However, the molecular mechanisms by which Abeta42 induces neuronal dysfunction and degeneration remain elusive. Mitochondrial dysfunctions are implicated in AD brains. Whether mitochondrial dysfunctions are merely a consequence of AD pathology, or are early seminal events in AD pathogenesis remains to be determined. Here, we show that Abeta42 induces mitochondrial mislocalization, which contributes to Abeta42-induced neuronal dysfunction in a transgenic Drosophila model. In the Abeta42 fly brain, mitochondria were reduced in axons and dendrites, and accumulated in the somata without severe mitochondrial …

Improved Inter-Rater Reliability For Sah Ct Grading Scales Through Application Of A Formal Definition Of Clot Thickness, William Mcbride, Md, Valerie Dechant, Md, Michael Moussouttas, Md

Department of Neurology Faculty Papers

Various scales have been devised for the prediction of vasospasm following aneurysmal rupture.

Especially prominent in these scales is their reliance upon a subjective assessment of clot thickness which introduces variability in grading across raters.

The current study seeks to compare the inter-rater reliability of the traditional Fisher and newer "Frontera" scale (Modified Fisher) when a rigid definition of thick clot is employed.

The Burden Of Stroke And Transient Ischemic Attack In Pakistan: A Community-Based Prevalence Study, Ayeesha Kamran Kamal, Ahmed Itrat, Muhammed Murtaza, Maria Khan, Asif Rasheed, Amin Ali, Amna Akber, Zainab Akber, Naved Iqbal, Sana Shoukat, Farzin Majeed, Danish Saleheen

Section of Neurology

Background: The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan. Methods:Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pretested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by …

Fdg Pet-Positive, Mri-Negative Patients With Temporal Lobe Epilepsy: Etiology And Outcomes Compared To Patients With Hippocampal Sclerosis, C. Lopinto Khoury, M. Sperling, C. Skidmore, M. Nei, A. Zangaladze, J. Evans, A. Sharan, S. Mintzer

Department of Neurology Faculty Papers

FDG PET hypometabolism is important for surgical planning in patients with temporal lobe epilepsy (TLE), but its significance remains unclear in patients who do not have evidence of Hippocampal Sclerosis (HS) on MRI.

Plantar Cutaneous Sensory Stimulation Improves Single-Limb Support Time, And Emg Activation Patterns Among Individuals With Parkinson's Disease, M. Jenkins, Q. Almeida, S. Spaulding, R. Van Oostveen, J. Holmes, Andrew Johnson, S. Perry

Andrew M. Johnson

Parkinson's disease is a chronic neurological disorder that results in gait and posture impairment. There is increasing evidence that these motor impairments may be partially due to deficits within the sensory system. In this study, the effects of a facilitatory insole that provides increased plantar sensory stimulation, was evaluated during gait, in a group of individuals with Parkinson's disease in comparison with healthy age-matched controls. Spatial-temporal parameters of gait were evaluated using an instrumented carpet, and muscle activation patterns were evaluated using surface EMG. All participants were tested with both a facilitatory (ribbed) insole and a conventional (flat) insole while …

Sonography Of The Neonatal Brain, Traci B. Fox

Department of Radiologic Sciences Faculty Papers

Neurosonography is a critical part of the care of the sick newborn. Sonography is superior to other modalities in imaging of the brain because it can be performed at the bedside, is easily reproducible, and does not require ionizing radiation or sedation. This article refreshes the sonographer in the normal anatomy and appear- ance of the neonatal brain using sonography, as well as some of the more common pathologic conditions that may be encountered.

Traumatic Thoracic Asia A Examinations And Potential For Clinical Trials, James S. Harrop, Md, Mitchell G. Maltenfort, Phd, Fred H. Geisler, Md, Phd, William Coleman, Phd, Linda A.T. Jones, Pt, Ms, Edward Wirth, Md, Alexander Vaccaro, Md, Phd

Department of Neurosurgery Faculty Papers

Study Design: Retrospective review of prospective database

Objectives: To define the variability of neurologic examination and recovery after non-penetrating complete thoracic spinal cord injuries (ASIA A).

Background Data: Neurologic examinations after SCI can be difficult and inconsistent. Unlike cervical SCI patients, alterations in thoracic (below T1) complete SCI (ASIA A – based on the ASIA Impairment Scale [AIS]) patients’ exams are based only on sensory testing, thus changes in the neurological level (NL) are determined only by sensory changes.

Methods: A retrospective review of the placebo control patients in a multicenter prospective database utilized for the pharmacologic trial of Sygen. …

Cost-Effectiveness Of Clipping Vs Coiling Of Intracranial Aneurysms After Subarachnoid Hemorrhage In A Developing Country-A Prospective Study, Muhammad Zubair Tahir, Ather Enam, Rushna Pervez Ali, Atta Bhatti, Tanveer Ul Haq

Section of Neurosurgery

Background: Endovascular coil treatment is being used increasingly as an alternative to clipping for some ruptured intracranial aneurysms. The relative benefits of these 2 approaches have yet to be fully established. The aim of this study was to compare the clinical outcome, resource consumption, and cost-effectiveness of endovascular. treatment vs surgical clipping in a developing country.
Methods: The study population consisted of 55 Patients with aneurysmal subarachnoid hemorrhage (SAH) identified prospectively from January 2004 to June 2007. Of the 55 Patients with ruptured intracranial aneurysms, 31 underwent surgical clipping, whereas 24 were treated via interventional coils. Clinical outcome at 6 …

The Production Of Antibody By Invading B Cells Is Required For The Clearance Of Rabies Virus From The Central Nervous System., D Craig Hooper, Timothy W Phares, Marzena J Fabis, Anirban Roy

Department of Cancer Biology Faculty Papers

BACKGROUND: The pathogenesis of rabies is associated with the inability to deliver immune effectors across the blood-brain barrier and to clear virulent rabies virus from CNS tissues. However, the mechanisms that facilitate immune effector entry into CNS tissues are induced by infection with attenuated rabies virus.

METHODOLOGY/PRINCIPAL FINDINGS: Infection of normal mice with attenuated rabies virus but not immunization with killed virus can promote the clearance of pathogenic rabies virus from the CNS. T cell activity in B cell-deficient mice can control the replication of attenuated virus in the CNS, but viral mRNA persists. Low levels of passively administered rabies …

Interventions For Autism Spectrum Disorders: State Of The Evidence, Lindsey Tweed Md, Mph, Nancy Connolly Mppm, Amy Beaulieu

Children, Youth, & Families

The number of children in Maine with Autism Spectrum Disorders (ASD) has increased significantly over the past decade. Since 2000, the number of children receiving Special Education services for ASD in Maine schools jumped from 594 to 2,231in 2008 – an increase of 276%. A recent study estimated that the total cost of caring for a person with autism over his or her lifetime can reach $3.2 million, with more than $35 billion spent collectively per year (Ganz, 2007). To conserve already scarce resources and of-fer the best possible services to children with ASD, it is necessary to identify and …

Orbital Aspergillus Infection Mimicking A Tumour: A Case Report, Muhammad Ahsan Zafar, Syeda Sidra Waheed, Ather Enam

Section of Neurosurgery

A 14-year-old male presented to the neurosurgical clinic with swelling just above the right eye which had been growing slowly for the last eight years. The swelling first appeared following a non-penetrating trauma eight years ago. On examination it was a non-tender, non-erythematous, firm, round swelling causing marked proptosis and diplopia on downward gaze only. The visual acuity was intact. MRI showed an intraorbital, extraconal mass isointense on T1 and hypointense on T2 imaging. A diagnosis of orbital tumor was made. A white, friable mass consistent with meningioma was resected. However histopathology report later showed it to be an Aspergilloma. …

Impairments In Attention In Occasionally Snoring Children: An Event-Related Potential Study., Maria E. Barnes, Elizabeth A. Huss, Krista N. Garrod, Eric Van Ray, Ehab Dayyat, David Gozal, Dennis L. Molfese

Faculty Scholarship

Objective: To determine whether minimal snoring is benign in children. Procedure: 22 rarely snoring children (mean age = 6.9 years, 11 females) and age- and sex-matched controls participated in an auditory oddball task wearing 128-electrode nets. Parents completed the Conners Parent Rating Scales–Revised Long (CPRS–R:L). Results: Snorers scored significantly higher on four CPRS-R:L subscales. Stepwise regression indicated that two ERP variables from a region of the ERP that peaked at 844 msec post-stimulus onset predicted CPRS-R:L Attention Deficit Hyperactivity Disorder (ADHD) Index scores. Conclusions: Occasional snorers, according to parental report, do exhibit ADHD-like behaviors. Basic sensory processing is longer than …

Transverse Myelitis In Pregnancy: A Case Report, Brian P. Mcdonald, Do, Nethra S. Ankam, Md

Department of Rehabilitation Medicine Faculty Papers

Objective: Describe the clinical course and treatment of a patient with paraplegia secondary to transverse myelitis during her pregnancy.

Setting: Acute Inpatient Rehabilitation Unit, University Hospital.

Participant: 36 year old Caucasian woman at 18 weeks gestation.

Interventions: Provided education and training on basic childcare tasks at a wheelchair level, and on how to obtain wheelchair accessible baby furniture. Provided availability of a peer who sustained a spinal cord injury prior to pregnancy. Maintained a close working relationship with maternal fetal health department regarding management of nausea and pain management, and educated team members about the possibility of autonomic …

Human Amniotic Fluid Stem Cells Do Not Differentiate Into Dopamine Neurons In Vitro Or After Transplantation In Vivo., Angela E Donaldson, Jingli Cai, Ming Yang, Lorraine Iacovitti

Farber Institute for Neuroscience Faculty Papers

Although embryonic stem (ES) cells can generate dopamine (DA) neurons that are potentially useful as a cell replacement therapy in Parkinson's disease (PD), associated ethical and practical concerns remain major stumbling blocks to their eventual use in humans. In this study, we examined human amniotic fluid stem (hAFS) cells derived from routine amniocenteses for their potential to give rise to DA neurons in vitro and following transplantation into the 6-hydroxydopamine-lesioned rat brain. We show that undifferentiated hAFS cells constitutively expressed mRNAs and proteins typical of stem cells but also cell derivatives of all three germ layers, including neural progenitors/neurons (nestin, …

Early And Late Treatment Of Migraine With Dhe Ns (Migranal®), Meryl Latsko, Md, Mph, Stephen D. Silberstein, Md

Department of Jefferson Headache Center papers and presentations

To examine the use of DHE NS (Migranal®) in the early and late treatment of migraine in subjects with a history of cutaneous allodynia.

Frovatriptan As Preemptive Treatment For Fasting-Induced Migraine, Meryl Latsko, Md, Mph, Stephen D. Silberstein, Md

Department of Jefferson Headache Center papers and presentations

To examine frovatriptan's efficacy as preemptive treatment for fasting-induced migraine.

Utilization Of Dantrolene In Stiff-Person Syndrome: A Case Report, John M. Vasudevan, Md, S. Kamal Fetouh, Md,, Nethra S. Ankam, Md, Adam L. Schreiber, Do, Ma

Department of Rehabilitation Medicine Faculty Papers

Setting: University hospital-based acute rehabilitation.

Patient: 75-year-old woman with Stiff-Person Syndrome (SPS) with a recent fall and Colles fracture.

Case Description: Four months prior to admission, the patient was diagnosed with SPS, negative for anti-GAD antibodies. Diagnosis was based on a 3-year history of progressive rigidity leading to frequent falls and fractures. Anxiety and fear of falling limited her mobility, and she sustained a sacral pressure ulcer during acute hospitalization. On admission, history was remarkable for unsteady gait and muscle cramps exacerbated when startled or excited. Examination was remarkable for rigidity in her axial and limb muscles. She presented …

Postulated Role Of Vasoactive Neuropeptide-Related Immunopathology Of The Blood Brain Barrier And Virchow-Robin Spaces In The Aetiology Of Neurological-Related Conditions, Donald R. Staines, Ekua W. Brenu, Sonya Marshall-Gradisnik

Sonya Marshall-Gradisnik

Vasoactive neuropeptides (VNs) such as pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) have critical roles as neurotransmitters, vasodilators including perfusion and hypoxia regulators, as well as immune and nociception modulators. They have key roles in blood vessels in the central nervous system (CNS) including maintaining functional integrity of the blood brain barrier (BBB) and blood spinal barrier (BSB). VNs are potent activators of adenylate cyclase and thus also have a key role in cyclic AMP production affecting regulatory T cell and other immune functions. Virchow-Robin spaces (VRSs) are perivascular compartments surrounding small vessels within the CNS and …

Safe Emergency Management Of Acute Ischemic Stroke: An Academic Community Hospital Decade Experience, John Castaldo, Richard S. Mackenzie Md, Peter J. Barbour Md, Lorraine Spikol, Yevgeniy Isayev, Yuebing Li Phd, Gary Clauser Md, John Margraf Md, Glenn Mackin Md, Faan, Facp, David Richardson, Gavin C. Barr, Jr. Md, Donna Jenny, Susan Nevada, Claranne Mathiesen

Department of Emergency Medicine

No abstract provided.

Relating Visual To Verbal Semantic Knowledge: The Evaluation Of Object Recognition In Prosopagnosia, Jason J. S. Barton, Hashim-M Hanif, Sohi Ashraf

Section of Neurology

Assessment of face specificity in prosopagnosia is hampered by difficulty in gauging pre-morbid expertise for non-face object categories, for which humans vary widely in interest and experience. In this study, we examined the correlation between visual and verbal semantic knowledge for cars to determine if visual recognition accuracy could be predicted from verbal semantic scores. We had 33 healthy subjects and six prosopagnosic Patients first rated their own knowledge of cars. They were then given a test of verbal semantic knowledge that presented them with the names of car models, to which they were to match the manufacturer. Lastly, they …

Mechanisms Of Primary Axonal Damage In A Viral Model Of Multiple Sclerosis., Jayasri Das Sarma, Lawrence C. Kenyon, Susan T. Hingley, Kenneth S. Shindler

Department of Neurology Faculty Papers

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS. Recent studies have demonstrated that significant axonal injury also occurs in MS patients and correlates with neurological dysfunction, but it is not known whether this neuronal damage is a primary disease process, or occurs only secondary to demyelination. In the current studies, neurotropic strains of mouse hepatitis virus (MHV) that induce meningitis, encephalitis, and demyelination in the CNS, an animal model of MS, were used to evaluate mechanisms of axonal injury. The pathogenic properties of genetically engineered isogenic spike protein recombinant demyelinating and nondemyelinating strains of MHV were compared. …

Modeling Brain Tumors Using Avian Retroviral Gene Transfer, Tod D. Holland, Eric C. Holland

Tod D Holland

RCAS/tv-a is a system for post-natal cell type specific gene transfer. It is used for the modeling of gliomas and medulloblastomas. This system provides a combination of lineage tracing from the cell origin with oncogenesis induced by mis-expression of specific genes. The genes that are most potent at inducing tumors are those that encode components of signal transduction and undifferentiated cells are most capable of serving as the cell of origin. The system effectively generates tumors with the histologic characteristics of human disease. Mice bearing RVAS/tv-a induced brain tumors are currently being used for preclinical trials to understand the biology …

Dynamic Mechanical (Brush) Allodynia In Cluster Headache: A Prevalence Study In A Tertiary Headache Clinic., Michael J Marmura, Muhammad Abbas, Avi Ashkenazi

Department of Jefferson Headache Center papers and presentations

Cutaneous allodynia (CA) has been described in migraine and has been related to treatment failure. There are little data about the incidence of CA in other primary headache syndromes such as cluster headache (CH). The objectives of this study are to evaluate the prevalence of dynamic mechanical (brush) allodynia (BA) in CH patients attending a tertiary headache clinic, and to assess its relation to disease characteristics. Adult patients with episodic or chronic CH were recruited. We obtained demographic data and data on disease characteristics through a structured questionnaire, and tested the patients for brush allodynia BA by applying a 4 …

The Karachi Intracranial Stenosis Study (Kiss) Protocol: An Urban Multicenter Case-Control Investigation Reporting The Clinical, Radiologic And Biochemical Associations Of Intracranial Stenosis In Pakistan., Ayeesha Kamran Kamal, Fawad Taj,, Babar Junaidi, Asif Rasheed, Moazzam Zaidi, Muhammed Murtaza, Naved Iqbal, Fahad Hashmat, Syed Vaqas Alam, Uzma Saleem, Shahan Waheed, Lajpat Bansari, Nabi Shah, Maria Samuel, Madiha Yameen, Sobia Naz, Farrukh Shahab Khan, Naveeduddin Ahmed, Khalid Mahmood, Niaz Sheikh, Karim Ullah Makki, Muhammad Masroor Ahmed, Abdul Rauf Memon, Mohammad Wasay, Nadir Ali Syed, Bhojo A Khealani, Philippe M. Frossard, Danish Saleheen

Department of Medicine

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner.

Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due …

Perioperative Complications Affecting Anesthetic Outcome In Intraventricular Neuroendoscopy, P. Ganjoo, Swati Sethi, M.S Tandon, Diljit Singh, Rajiv Chawla, B.C Pandey

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

A Study On The Effect Of Baby Walker On Mean Age Acquisition Of Motor Skills In Infants, Ahmad Talebian, Ali Honarpishe, Abbas Taghavi, Esmail Fakharian, Mahdi Parsa, Gholam Abbas Mousavi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Bilateral Cerebellar Stroke With Good Functional Recovery, Maimoona Siddiqui, Farrukh Shohab Khan, Mohammad Salman

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Cirsoid Aneurysm With Impending Rupture, Amit Agrawal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Surgical Management Of Non -Suppurative Brain Lesions (Part I), Muhammad Shahzad Shamim, Syed Ather Enam, Rushna Pervez Ali, Syed Faizan Ali, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.